Employment Application - Comfort House Inc. Dumpster Toilet Rental

Applicant Information

Date*

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Date Available to Start Work

Last four digits of SSN*

Desired Salary

Position Applied For

Type of Employment Desired

Full-time
Part-Time
Temporary

Are you a citizen of the United States?*

Yes
No

If no, are you authorized to work in the United States?*

Yes
No

Have you ever worked for Comfort House, Inc.?*

Yes
No

If so, when?

Are you employed now?*

Yes
No

If so, may we contact your employer?

Yes
No

Education and Office Skills

High School

Address

City State

Attended from

To

Did you graduate?

Yes
No

College or Trade School

Address

City State

Attended from

Enter date

To

Enter date

Did you graduate?

Yes
No

Degree

Years of Typing Experience

Words per Minute

Other Office Equipment Used

Computer Software or Hardware Experience

Employment History

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name and Position of Supervisor

Your Job Title

Starting Salary

Ending Salary

Responsibilities

Employed From

To

Reason For Leaving

May we contact your previous supervisor for a reference?

Yes
No

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name and Position of Supervisor

Your Job Title

Starting Salary

Ending Salary

Responsibilities

Employed From

To

Reason For Leaving

May we contact your previous supervisor for a reference?

Yes
No

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name and Position of Supervisor

Your Job Title

Starting Salary

Ending Salary

Responsibilities

Employed From

To

Reason For Leaving

May we contact your previous supervisor for a reference?

Yes
No

Military Service

Did you serve in the military?

Yes
No

Branch

Served From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Type Name for Signature.

Date*