Employment Application

Date:   Social Security Number: 
Name: ,
Present Address
,  
Permanent Address
,  
Phone No:  Are you at least 18 years of age?  YesNo
Email Address:
Name and Dept. of any relatives employed by Valley Offset Printing
How did you hear about us?  AdvertisementEmployment AgencyFriendRelativeOther

Shift Preferred:  Position:  Salary:
Date You Can Start:   Will You Work Overtime If Needed?  YesNo
If Employed, May We Inquire of Your Last Employer?  YesNo
Have You Ever Applied at Valley Offset Printing Before?  YesNo If YES, When? 
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?  YesNo

High School
Year Completed:  1234
Graduated?  YesNo

College
Year Completed:  1234
Graduated?  YesNo

Trade or Business School
Year Completed:  1234
Graduated?  YesNo

As an Equal Opportunity Employer, Valley Offset Printing will not discriminate against any employee or applicant for employment because of race, religion, sex, age, national origin, disability, veteran’s status or any other unlawful basis

List your last four (4) employers beginning with the most recent
First
Date - Month & Year
Name Of Employer & Supervisor
Address
Position & Salary
Reason For Leaving



Second
Date - Month & Year
Name Of Employer & Supervisor
Address
Position & Salary
Reason For Leaving



Third
Date - Month & Year
Name Of Employer & Supervisor
Address
Position & Salary
Reason For Leaving



Fourth
Date - Month & Year
Name Of Employer & Supervisor
Address
Position & Salary
Reason For Leaving



List below the names of three persons NOT related to you, whom you have known at least one year.
 
Name
Address
Business
Years Acquainted
1.
2.
3.
Have you ever been convicted of a felony?  YesNo
Please provide details: 
In case of emergency, notify:

I authorize investigation of all statements contained in this application and I release all references listed above, schools, current and past employers, from all liability for any damage or claim that may result from furnishing information to Valley Offset Printing. I understand that misrepresentation or omission of facts requested will result in refusal to employ me or my dismissal if I am employed. Further, I understand and agree that my employment is for no definitive period and may, regardless of date of employment or any wages and salary, be terminated at any time, with or without my previous notice, at the option of either Valley Offset Printing or me.
Date: 
 
0

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