Brag Sheet

Personal Information
Name

Social Security Number
Present Address  

Permanent Address

Are You 18 Years or Older               YesNo

Are You Either A U.S. Citizen Or An Alien Authorized To Work In The United States?   YesNo

Have you been convicted within the previous two years of a violation of any intoxicating liquor law of Kansas, or any other state, or the United States?  YesNo If yes, what was the date of the conviction?

 
Employment Desired

Position Date you can start Salary Desired

Are you employed now? YesNo  If so, may we inquire of your present employer? YesNo

Ever applied to this company before? Yes  No Where? When?

Education Name and Location of School Number of Years Attended Did you Graduate? Subjects Studied
Grammar School Yes No
High School Yes No
College Yes No
Trade, Business or Correspondence School Yes No
*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.

 

Availability
Are you restricted to working?
Certain hours: Yes No     If yes, list hours available
Certain days: Yes No If yes, check days available: M T W Thurs F Sat Sun

 

Former Employers

(List below last three employers, starting with last one first)
Date, Month, Year Name and Address of Employer Salary Position Reason for leaving
From

To
From

To
From
To

References

(List below last three employers starting with last one first)
Name Address Business Years Acquainted
1
2
3
Person to contact in case of an emergency Phone Number

Please list below any information which you believe would be beneficial in helping Carrolliffic Employment Agency make its hiring decision:

This application must be completed in full to be considered a valid application for employment. Incomplete applications will be rejected and you will not be considered for employment.

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of date of payment of my wages and salary, be terminated at any time without prior notice.

I agree with policy above  I do not agree with policy above

 

Carrolliffic Employment Agency

"Finding great jobs for great kids!"