Employment Application Personal Information Date: Social Security Number: Name: , Present Address , AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Permanent Address , AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY 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 Employment Desired 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 Education High School Year Completed: 1234Graduated? YesNo College Year Completed: 1234Graduated? YesNo Trade or Business School Year Completed: 1234Graduated? 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 Former Employers 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 References 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: Authorization 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:
