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Do you have any physical defects that preclude you from performing any work for which
you are being considered?
Where you ever injured?				Give Details:
In case of emergency, notify:

 

 

 

Former Employers

(List below your last four employers, starting with the most recent one first.)

Date (M/Y)		Name & Address of Employer	Salary	Position	Reason Left
From:
To:
From:
To:
From:
To:
From:
To:

 

References

	Name	Address & Phone	Business	Years Known
1
2
3

 

This form has been designed to comply with State and Federal Fair Employment Practice laws prohibiting discrimination on the basis of an applicant’s sex or minority status. Questions directly or indirectly reflecting such status have been included only where needed to determine a bona fide occupational qualification or for other permissible purposes. Such questions are appropriately noted on the application.

 

"I certify that the information I have provided is true and accurate to the best of my knowledge. I understand that providing false information on this application is grounds for termination should I become employed by National Framing & Remodeling Inc.. I authorize National Framing & Remodeling Inc. to verify the information provided on this application by contacting the educational institutions, employers, and references named; I release all parties from any liability or damage that may result from verifying such information. I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time without prior notice."

 

 

Signature:__________________________________                                             Date: ________________