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Employment Application

Employment Application

(* - Indicates a REQUIRED field)

PERSONAL:

Name*: (Last, First, Middle Initial)

Date of Application:

Street Address*:

City*:

State*:

Zip Code*:

Email Address*:

Phone Number*:

Home

Work

Cell

Division

Position Applied:

Type of employment desired?*

Date Available to Start*:

Are you authorized to work in the United States?* Yes No

(If offered employment, you will be required to provide documentation to verify eligibility)

Have you ever worked for this company?* Yes No

If yes, when?

EDUCATION:

Please complete the following fields to include all requested levels of education. If a question is not applicable, please indicate by entering N/A (Not Applicable).

High-school

Name

Location

Did you graduate?

Yes

No

Diploma

College

Name

Location

Did you graduate?

Yes

No

Degree

Other Training or Degree

Name

Address

Did you graduate?

Yes

No

Degree/Certification

PREVIOUS EMPLOYMENT

Please list all former employers and positions held.

Most Recent

Company:

Phone Number:

Home

Work

Cell

Street Address:

City:

State:

Zip Code:

Job Title:

Supervisor:

Start date:

End:

Reason for Leaving:

May we contact for a reference?*

Yes

No

Please enter any additional information about former employment, position, and times in the space below as needed.

Job 2

Company:

Phone Number:

Home

Work

Cell

Street Address:

City:

State:

Zip Code:

Job Title:

Supervisor:

Start date:

End:

Reason for Leaving:

May we contact for a reference?

Yes

No

Job 3

Company:

Phone Number:

Home

Work

Cell

Street Address:

City:

State:

Zip Code:

Job Title:

Supervisor:

Start date:

End:

Reason for Leaving:

May we contact for a reference?

Yes

No

MILITARY SERVICE:

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

References

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

Name 1:*

Address:*

Phone:*

Relationship:*

Years known:*

Name 2:*

Address:*

Phone:*

Relationship:*

Years known:*

Name 3:*

Address:*

Phone:*

Relationship:*

Years known:*

Upload Resume

Resume in PDF format:

DISCLAIMER AND SIGNATURE

I hereby certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in immediate release or termination of employment. I further understand that false, misleading, or incomplete information may result in a rejection of my application and/or disqualification from employment.

I authorize the investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for this is cause for immediate dismissal. Further, I understand and agree that my employment is for no definite period of time, and I may be terminated at any time without notice.

Applicant Name / Electronic Signature*:

Date of Application:

Is the applicant the submitter of this form?

Yes

No

If not, who is the submitter?

What is your relationship to the applicant?

Service Area

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Contact Us

Petcosky Companies

421 Commerce Rd
Vestal, NY 13850

12210 ITEC Haul Drive #101,
Fort Myers, FL 33913

Copyright © Petcosky Companies. All rights reserved.

NY State Phone Numbers

Phone: (607) 296-7969 NY
Fax: (607) 770-4482

FL State Phone Number

Phone: (239) 387-2277 FL