Name:*
Present Address:
Permanent Address:*
Phone:*
-
E-mail:*
Secondary Phone:
-
Referred by:

Employment Desired



Position:
Date you can start:
Salary Desired:
Are you employed now?
If so, may we inquire of your present employer?:
Are you legally authorized to work in the U.S.?:
Ever applied to The Caroline before?:
Where:
When:

Education History



High School

Name and Location of High School:
Years attended High School:
Did you graduate High School?:
Subjects Studied in High School:

College

Name and Location of College:
Years attended college:
Did you graduate college?:
Subjects Studied in college:

Trade, Business, or Correspondence School

Name and Location of trade, business, or correspondence school:
Years attended trade, business, or correspondence school:
Did you graduate trade, business, or correspondence school?:
Subjects Studied in trade, business, or correspondence school?:

General Information



Subject of special study/research work:
Special Training:
Special Skills:
U.S. Militray or Naval Service:
Rank:

Former Employers


(Starting with last one first)

Former employer's name and address (1):
Dates Employed (1):
Salary (1):
Position (1):
Reason for leaving employer (1):
Former employer's name and address (2):
Dates Employed (2):
Salary (2):
Position (2):
Reason for leaving employer (2):
Former employer's name and address (3):
Dates Employed (3):
Position (3):
Salary (3):
Reason for leaving employer (3):

References


(Give the names of three persons not related to you, whom you have known for at least one year)

Reference name (1):
Reference address (1):
Business (1):
Years known (1):
Reference name (2):
Reference address (2):
Business (2):
Years known (2):
Reference name (3):
Reference address (3):
Business (3):
Years known (3):

Authorization


"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 the references and employers listed above to give you and and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. 

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

Digital Signature:*
Date:*