Online Application For Employmen

148 Chester Court Bowling Green, KY 42103 Phone - (270) 843-2247 Fax - (270) 843-9323
750 West 15th Street Hopkinsville, KY 42240 Phone - (270) 885-9893 Fax - (270) 885-9869

Online Application For Employment for DDS ENGINEERING, PLLC

DDS ENGINEERING, PLLC is an equal opportunity employer and does not discriminate on the basis of sex, race, color, religion, age, disability, status as a special disabled veteran or veteran of the Vietnam era, national or ethnic origin, or sexual orientation.

"An Equal Opportunity Employer"

DATE:

PERSONAL INFORMATION:

Full Name (First, Middle, Last):

Present Address:

APT No.:

City:

State:

Zip:

Permanent Address:

APT No.:

City:

State:

Zip:

Are You 18 Years Or Older?

Yes No

Phone:

DESIRED EMPLOYMENT:

Position Desired?

Date You Can Start?

Salary Desired?

Indicate Types Of Employment You Are Willing To Accept?
Full Time Part Time Temporary

Are You Willing To Work Overtime?
Yes No

Are You Willing To Work Out of Town?
Yes No

Are You Employed Now?
Yes No

If So, May We Contact Your Present Employer?
Yes No

Ever Applied To This Company Before?
Yes No

Where?

When?

Ever Worked For This Company Before?
Yes No

Where?

When?

Who Referred You To This Company?
Employment Agency Newspaper Advertisement Friend Walk In

EDUCATION:

School Level	Name And Location Of School	No. Of Years Attended	Did You Graduate?	Subjects Studied
GRAMMAR SCHOOL			Yes No
HIGH SCHOOL			Yes No
COLLEGE			Yes No
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL			Yes No

GENERAL:

SUBJECTS OF SPECIAL STUDY OR COLLEGE DEGREES

MATH RELATED COURSES

COMPUTER SKILLS

MILITARY (leave blank if not appropriate):

Branch Of Service	Date Of Entry
Date Of Separation	Nature Of Discharge

INDICATE RESERVE OR NATIONAL GUARD STATUS, IF ANY

FORMER EMPLOYERS:

LIST BELOW LAST THREE EMPLOYERS, STARTING WITH THE MOST RECENT ONE FIRST

Name of Last Or Present Employer (1):

Location Of Employer:

Starting Date

Leaving Date

Job Title

Weekly Starting Salary

Weekly Final Salary

May We Contact Your Supervisor?
Yes No

Name Of Supervisor

Job Title

Phone

Description Of Work

Reason For Leaving

Name of Last Or Present Employer (2):

Location Of Employer:

Starting Date

Leaving Date

Job Title

Weekly Starting Salary

Weekly Final Salary

May We Contact Your Supervisor?
Yes No

Name Of Supervisor

Job Title

Phone

Description Of Work

Reason For Leaving

Name of Last Or Present Employer (3):

Location Of Employer:

Starting Date

Leaving Date

Job Title

Weekly Starting Salary

Weekly Final Salary

May We Contact Your Supervisor?
Yes No

Name Of Supervisor

Job Title

Phone

Description Of Work

Reason For Leaving

REFERENCES:

BELOW, GIVE THE NAMES OF THREE PERSONS YOU ARE NOT RELATED TO, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR

	Name	Address	Business	Years Acquainted
1
2
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 ANY 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."

DATE :

FULL NAME

E-MAIL ADDRESS