Online Employment Application

An Equal Opportunity Employer

This application will remain active for 90 days

SECTION 1 - POSITION INFORMATION
Date:
Position Desired:
Date Avaliable:
 /
Reffered By:
 If EMPLOYEE; Employee name:
Minimum Earnings Required:
Shift Preferred:
Have You ever Applied here before?
  If YES: When? Name?
   

 

SECTION 2- GENERAL INFORMATION
Last Name:
First Name:
Middle:
Telephone:
 Home:
Work:
Cell:
Home Address(Street and Number):
City:
State:
Zip:
Social Security Number:
Are you over 18?
  If no, a work permit will be required for employment.
Parents or Guardian if Minor Applicant (Name and Address):
 
Friends or Relatives employed by Kerr Norton Strachan Agency:
 
 
   

 

SECTION 3- LICENSING
(Identify each license or certification held, include serial numbers and expiration date)
 

 

SECTION 4- OFFICE SKILLS (Clerical applicants only)
Typing:
 WPM:
Shorthand:
 WPM:
Dictaphone:
Calculator:
Computer:
What Software?

 

SECTION 5- MISCELLANEOUS
(List special language skills, scholarships, or other activities significant to the position applied for (exclusive of information pertaining to race, sex, religion, national origin, age, citizenship, or disability)
 

 

SECTION 6- MILITARY (A copy of Military Discharge Papers may be requested after hire)
Were you ever in the U.S. Armed Force?
Branch?
Reserve Status:
Starting Rank:
Rank at Seperation:
Date of Entry:
Date of Seperation:
Specialized Training or Experience:

 

SECTION 7- EDUCATION
High School: Name: Location:
  Dates From: To:
  Degree/Field of Study:
 
College or University:: Name: Location:
  Dates From: To:
  Degree/Field of Study:
 
Graduate School: Name: Location:
  Dates From: To:
  Degree/Field of Study:
 
Business or Vocational: Name: Location:
  Dates From: To:
  Degree/Field of Study:
 
Other: Name: Location:
  Dates From: To:
  Degree/Field of Study:
 

 

SECTION 8- EMPLOYMENT HISTORY
(Account for the past 10 years. Include periods of unemployment, self-employment, schooling, or military service. List present position first. Please include any other name under which your records may appear)
May we contact your present employer?
Past employers?
 
Name of Employer:
Telephone Number:
Dates:
 From: To:
Address:
Type of Business:
Ending Salary:
Job Title & Responsibility:
Reason for Leaving:
 
Name of Employer:
Telephone Number:
Dates:
 From: To:
Address:
Type of Business:
Ending Salary:
Job Title & Responsibility:
Reason for Leaving:
 
Name of Employer:
Telephone Number:
Dates:
 From: To:
Address:
Type of Business:
Ending Salary:
Job Title & Responsibility:
Reason for Leaving:
 

 

SECTION 9- PROFESSIONAL REFERENCE
Name:
Position:
Address:
Phone:
 
Name:
Position:
Address:
Phone:
 
Name:
Position:
Address:
Phone:

 

SECTION 10- SECURITY  
A. Are you legally eligible to work in the U.S.?
If hired to work at Kerr Norton Strachan Agency, you will be required to furnish documentation within 3 working days that you are a legal resident and/or legally entitled to work in the U.S.
B. Have you ever been convicted of a felony within the past seven years?
If yes, briefly describe the circumstances of your conviction, indicating the date, nature, and place of the offense, and the disposition of the case. A felony will not bar you from employment since this will be looked upon as only one of the factors considered in the employment decision and is evaluated in terms of nature, severity, and date of the offense.
 

 

SECTION 11- CONDITIONAL OFFER OF EMPLOYMENT
Kerr Norton Strachan Agency does not discriminate against anyone on the basis of race, age, creed, sex, religion, color, national origin, disability, veteran, or citizenship status.

During our initial or subsequent processing of your application for employment, a reference inquiry may be made which will provide applicable information concerning character, general reputation, and personal characteristics. We may also verify such dates of employment, past or present salary, and reasons for leaving previous employers. Omissions or misstatements of material facts may be considered cause for dismissal. Upon your written request, we will provide you with additional information as to the nature and scope of the inquiry, if one is made.

I CERTIFY THAT THE ANSWERS GIVEN BY ME TO THE FOREGOING QUESTIONS AND STATEMENTS ARE TRUE AND CORRECT WITHOUT CONSEQENTIAL OMMISSION OF ANY KIND WHATSOEVER. I AGREE THAT KERR NORTON STRACHAN AGENCY SHALL NOT BE LIABLE IN ANY RESPECT IF MY EMPLOYMENT IS TERMINATED BECAUSE OF FALSIFICATION OF STATEMENTS, ANSWERS, OR OMISSIONS MADE BY ME IN THIS APPLICATION. I ALSO UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS TERMINABLE AT WILL SO THAT EMPLOYMENT SHALL CONTINUE ONLY AS LONG AS IT IS MUTUALLY AGREEABLE; AND FURTHER, NOTHING IN THIS APPLICATION IN ANY WAY CREATES AN EXPRESSED OR IMPLIED CONTRACT OF EMPLOYMENT BETWEEN KERR NORTON STRACHAN AGENCY AND ME.

I authorize the companies, organizations, schools, or persons named above to give any information regarding my employment or scholastic standing, together with any other information they may have.
 
SIGNATURE (please type full name): DATE:

 
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