APPLICANT INFORMATION

Last Name      First      M.I. Date
Street Address Apt/Unit #
City      State      Zip
Home Phone (Not a cell)           Cell Phone (If available)
Emergency Contact: Relation Phone
E-mail Soc Sec No Desired Salary
Position Applied for
Are you a U.S. citizen?
If not, are you authorized to work in the U.S.?
Have you ever worked for this company?
If so, when?
Have you ever been convicted of a felony?
If yes, explain.

EDUCATION

High School Address
From To     Did you graduate?   Degree

College Address
From To    Did you graduate? Degree

Other Address
From To    Did you graduate?    Degree

 

REFERENCES
Please list three professional references.

Full Name Relationship
Company Phone
Address

Full Name Relationship
Company Phone
Address

Full Name Relationship
Company Phone
Address

AVAILABILITY

Apart from absence for religious observance, are you available to work full time?
Will you work overtime if asked?
Please check your preferred work schedule:

Section A:
 
I am only available to work Part Time because:
   
Section B:  
Please specify the hours you are available to work. Check None on any day you will not be available.
  Monday From   To
  Tuesday From   To
  Wednesday From   To
  Thursday From   To
  Friday From   To
  Saturday From   To
  Sunday From   To
Section C:  

On what day will you be able to start work?

 

VEHICLE(S)
Please provide information regarding the vehicle(s) you own and may use during the course of your employment.

Vehicle #1
Year Make Model Color
License Plate # Registration Expiration (mm/yy)

Vehicle #2
Year Make Model Color
License Plate # Registration Expiration (mm/yy)

 

AUTOMOBILE INSURANCE

All of our drivers must abide by California law and keep a copy of their current registration and proof of current insurance in their vehicle at all times. You must also keep your current driver's license in your possession at all times while operating a motor vehicle.

 

PREVIOUS EMPLOYMENT

Company                   Phone
Address              Supervisor
Job Title    Starting Salary $    Ending Salary $
Responsibilities
From   To
Reason for Leaving
May we contact your previous supervisor for a reference?

Company                   Phone
Address              Supervisor
Job Title    Starting Salary $    Ending Salary $
Responsibilities
From    To
Reason for Leaving
May we contact your previous supervisor for a reference?

Company                   Phone
Address              Supervisor
Job Title    Starting Salary $    Ending Salary $
Responsibilities
From   To
Reason for Leaving
May we contact your previous supervisor for a reference?

 

MILITARY SERVICE

Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain

 

DISCLAIMER AND SIGNATURE

I hereby declare that the information provided by me on this application is true, correct and complete tot he best of my knowledge. I understand that if employed, any misstatements or omission of fact shall be considered cause for my dismissal. I understand I am required to abide by all rules and regulations of Eclipse Messenger Service, Inc. I also understand and agree that if I am hired, my employment is for no definite period, and may regardless of the date of payment of any wage or salary, be terminated at any time without previous notice.

I authorize any investigation of my prior work history, references, criminal history and military service as well as any and all other information contained on this application to determine my eligibility for employment with Eclipse messenger Service, Inc.

I consent to the above terms of employment: