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Rockingham
Taxi PO Box
671 Greenland NH 03840 |
Full Name: |
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Date: |
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Last |
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M.I. |
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Address: |
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Street Address |
Apartment/Unit # |
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City |
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ZIP Code |
Phone: |
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Date Available: |
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Social Security No.: |
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Desired Salary: |
$7.25 hr |
Position Applied for: |
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Are you a citizen of the |
YES |
NO |
If no, are you authorized to work in the U.S.? |
YES |
NO |
Have you ever worked for this company? |
YES |
NO |
If yes, when? |
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Have you ever been convicted of a felony? |
YES |
NO |
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If yes, explain: |
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High School: |
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Address: |
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From: |
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To: |
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Did you graduate? |
YES |
NO |
Diploma:: |
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College: |
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Address: |
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From: |
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To: |
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Did you graduate? |
YES |
NO |
Degree: |
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Company: |
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Phone: |
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Address: |
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Supervisor: |
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Job Title: |
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Starting Salary: |
$ |
Ending Salary: |
$ |
Responsibilities: |
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From: |
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To: |
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Reason for Leaving: |
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May we contact your previous supervisor for a reference? |
YES |
NO |
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Company: |
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Phone: |
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Address: |
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Supervisor: |
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Job Title: |
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Starting Salary: |
$ |
Ending Salary: |
$ |
Responsibilities: |
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From: |
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To: |
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Reason for Leaving: |
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May we contact your previous supervisor for a reference? |
YES |
NO |
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I certify that my answers are true and complete to 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.
Signature: |
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Date: |
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Please include a Picture of
your face that can be used as a passport photo.