OLD DELMAE EMPLOYMENT APPLICATION

Email

If yes, please describe the crime—state the nature of the crime(s), when and where convicted, and the disposition (final settlement) of the case.

Desired salary or hourly rate of pay

$

Hours available to work

EDUCATION & EXPERIENCE

High School

School City, State

Number of years completed

College/University/Vocational School

City, State

Number of years completed

Degree/Diploma earned

Skills and Qualifications: Licenses, Skills, Training, Awards

EMPLOYMENT HISTORY

Name of employer 1

Name of supervisor

Employer 1 City, State

Length of employment (include dates)

Position held

Responsibilities

Reason for leaving

Ending salary or hourly rate of pay

$

Name of employer 2

Name of supervisor

Employer 2 City, State

Length of employment (include dates)

Position held

Responsibilities

Reason for leaving

Ending salary or hourly rate of pay

$

CERTIFICATION

By entering my name below, 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 authorize the references and employers listed above to give Old Delmae any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Old Delmae from any liability for any damage that may result from utilization of such information.