1. * Position Applying For
   

1. * Name (first, middle, last)
   
2. * Home Address
   
3. * Home Phone Number
   
4. Alternate Phone Number
   
5. * Email
   
6. * Are you authorized to work in the U.S. on an unrestricted basis?
    Yes
    No
7. Are you over the age of 18?
    Yes
    No
   1. If under 18, can you furnish a work permit?
       Yes
       No
8. Have you ever been convicted of a felony?
    Yes
    No
   1. If yes, explain
9. * Who referred you to us?
    Agency
    Ad
    Employee
    Internet
    Relative
    Walk in
    Other
10. * First date available for work
    
11. * Starting Salary Desired
    

1. Have you applied for employment here before?
    Yes
    No
   1. If Yes, Position Applied for
      
   2. When
      
2. Have you ever been employed here?
    Yes
    No
   1. Dates
      
   2. Department
      
3. Are you currently employed?
    Yes
    No
   1. If yes, may we contact your employer?
       Yes
       No
4. Are you willing to travel if the job requires it?
    Yes
    No
5. Are you available for full-time work?
    Yes
    No
6. Are you available for part-time work?
    Yes
    No
7. Are you currently on layoff or leave from another company and subject to recall?
    Yes
    No

1. * High SchoolPlease list Name and Location of school(s).
2. * College/UniversityPlease list Name and Location of school(s), and the year you graduated, your Major, and diploma/degree.
3. * OtherPlease summarize other training/education, special job-related skills, computer, qualifications, certifications, license(s) acquired from employment, military or other experience

Please supply your employment history covering the last 10 years, starting with your present or most recent job. Include military service and voluntary activities. Exclude organizations which indicate race, color, gender, national origin, disability or other legally protected status

I certify that the information given in this application is true and complete to the best of my knowledge. I understand that any false or incomplete answers or statements made by me in this application or other documents or interviews will be considered sufficient reason for denial of employment or discharge.

I hereby authorize Georgetown College to conduct an investigation of my employment, education and training, which would include verification of the information set forth on this application for employment. I further release from all liability any and all persons or entities who supply such information and Georgetown College in its use of such information.

I further understand and agree that my employment is for no definite period and may, regardless of the date of payment of wages or salary, be terminated for any reason and at any time without previous notice by me or the College.

• 
  * I hereby acknowledge that I have read and understand the above statements.