Confidential Application for Employment

I understand and agree that any false information provided herein may be cause for denial of employment or dismissal in the event of employment. As an applicant for a position with Stenbeck & Taylor, Inc., I hereby authorize the release of information regarding my education and work history for use to determine my qualifications for employment.

Position Applied For:______________________________________Date: ___________________________

Signature:
______________________________________________________________________________
Name:
First:_________________________ MI: __________Last:________________________________________
Present Address:
Street: _________________________________________________________________________________
City: _________________________________________State: _______________ ZIP: _________________
Have you ever been convicted of a crime? _____Yes _____No
If Yes, describe in full:






Are you legally authorized to work in the United States? _____Yes _____No
Do you have a current Valid Driver's License? _____Yes _____No
Educational Background: (List most recent first)
School
Location
# of years
completed
Graduated
(Y / N)
Degree Received

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Skills And Qualifications:
List any Professional License or Certification that are currently valid:
Sate or other Licensing Authority
Year of Licensure
License No.
Expiration Date

 

 

    

 

 

    

 

 

    
Affiliations:
Name of Organization:
Type of Affiliation:
How Long?

 

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List special qualifications and/or skills with machines and equipment (office or survey equipment, public speaking, computer applications, computer hardware and software, etc...)
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Professional Experience: (You may attach a word document summarizing your experience)

Employer
Name / Address

Type of BusinessDates of Employment Job TitleAvg. Hrs per week

 

 

 

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Number of employees you supervisedStarting SalaryEnding SalaryDescribe your duties, responsibilities and accomplishmentsWhy did you leave?

 

 

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May we contact this employer? _____Yes _____No

Professional Experience: (You may attach a word document summarizing your experience)

Employer
Name / Address

Type of BusinessDates of Employment Job TitleAvg. Hrs per week

 

 

 

....
Number of employees you supervisedStarting SalaryEnding SalaryDescribe your duties, responsibilities and accomplishmentsWhy did you leave?

 

 

....
May we contact this employer? _____Yes _____No

Professional Experience: (You may attach a word document summarizing your experience)

Employer
Name / Address

Type of BusinessDates of Employment Job TitleAvg. Hrs per week

 

 

 

....
Number of employees you supervisedStarting SalaryEnding SalaryDescribe your duties, responsibilities and accomplishmentsWhy did you leave?

 

 

....
May we contact this employer? _____Yes _____No
Upon request, candidate must provide documentation of any attainments claimed on this application form to include: certificates, visas, degrees, registrations, etc.
Your application will be held in confidence
Please mail to the attention of:
Brian Taylor, President
Stenbeck & Taylor, Inc.
844 Webster Street, Suite 3
Marshfield, MA 02050