Personal Data
_________________________________________________________________________________________________________________________________________________________
NAME LAST FIRST MIDDLE INITIAL FORMER NAME(S)
_
________________________________________________________________________________________________________________________________________________________
P
RESENT MAILING ADDRESS STREET CITY STATE AND ZIP CODE
_
________________________________________________________________________________________________________________________________________________________
Y
OUR PRESENT TELEPHONE NUMBER ALTERNATE TELEPHONE NUMBER E-MAIL ADDRESS if available
ARE YOU OVER 18?
YES NO
IF UNDER AGE 18, CAN YOU SUPPLY WORKING
P
APERS?
Y
ES
N
O
Your Job Interests
T
ype of Employment for which you are applying: (check all that apply)
F
ull Time
P
art Time
T
emporary
S
ummer
Day Shift Evening Shift Night Shift Weekends
W
hen are you available to begin work? __________________________________________________________________________ Minimum Salary Desired? ________________________
Position applied for:__________________________________________________________________________________________ Application Date: _______________________________
Employment Experience
Starting with present or most recent. List all previous employers. Include self-employment, summer and part-time jobs. If more space is required, please continue on a separate sheet.
DATES WORKED SALARY TITLE
FROM TO
LAST OR PRESENT COMPANY BRIEF DESCRIPTION OF JOB DUTIES
STREET ADDRESS PHONE NUMBER
CITY STATE ZIP
S
UPERVISOR’S NAME AND TITLE PHONE NUMBER
REASON FOR LEAVING
DATES WORKED SALARY TITLE
F
ROM TO
LAST OR PRESENT COMPANY BRIEF DESCRIPTION OF JOB DUTIES
STREET ADDRESS PHONE NUMBER
CITY STATE ZIP
SUPERVISOR’S NAME AND TITLE PHONE NUMBER
REASON FOR LEAVING
DATES WORKED SALARY TITLE
FROM TO
LAST OR PRESENT COMPANY BRIEF DESCRIPTION OF JOB DUTIES
STREET ADDRESS PHONE NUMBER
CITY STATE ZIP
SUPERVISOR’S NAME AND TITLE PHONE NUMBER
REASON FOR LEAVING
DATES WORKED SALARY TITLE
FROM TO
LAST OR PRESENT COMPANY BRIEF DESCRIPTION OF JOB DUTIES
STREET ADDRESS PHONE NUMBER
CITY STATE ZIP
SUPERVISOR’S NAME AND TITLE PHONE NUMBER
REASON FOR LEAVING
 Main Street, Amherst, NY -
Employment Application
We appreciate your interest in Daemen College. While you may attach a resume, you are also
a
sked to complete the application in its entirety so that we can fully evaluate your qualifica-
tions. We are an equal opportunity/affirmative action employer. We will not discriminate
on the basis of race, religion, national origin, sex, age, or disability, veteran or marital status,
color, genetic predisposition or carrier status. Information provided on this application will
not be used for discriminatory purposes. Your application will remain on file for one year.
O
NLY U.S. CITIZENS OR ALIENS WHO HAVE A LEGAL RIGHT TO WORK IN THE U.S. ARE ELIGIBLE FOR
EMPLOYMENT. CAN YOU, UPON EMPLOYMENT PROVIDE GENUINE DOCUMENTATION ESTABLISHING YOUR
I
DENTITY AND ELIGIBILITY TO BE LEGALLY EMPLOYED IN THE UNITED STATES? Y
ES
N
O
Education and Training
TYPE OF
SCHOOL
H
IGH
SCHOOL
OR
EQUIVALENCY
DIPLOMA
ALL
V
OCATIONAL
SCHOOLS,
TECHNICAL
INSTITUTES,
COMMUNITY
AND JUNIOR
C
OLLEGES
ALL
O
THER
COLLEGES
OR
UNIVERSITIES
COMPLETE NAME AND
ADDRESS OF SCHOOL
FULL NAME
YEARS
KNOWN
PRESENT BUSINESS OR HOME ADDRESS
(NUMBER, STREET, CITY, STATE AND ZIP CODE)
BUSINESS OR
OCCUPATION TELEPHONE
DATES ATTENDED
FROM TO
MAJOR FIELDS
OF STUDY
DID YOU
GRADUATE?
TYPE OF DIPLOMA, DEGREE OR
CERTIFICATE
______________________________________________________________________________________________________________________________________________________________________________________________________________________
LIST SPECIAL QUALIFICATIONS AND SKILLS WITH MACHINES AND EQUIPMENT (OFFICE, PRINTING, WORD PROCESSING, PUBLIC SPEAKING, COMPUTER HARDWARE OR SOFTWARE, ETC.)
______________________________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________
LIST CURRENT PROFESSIONAL LICENSES OR CERTIFICATES (I.E. PLUMBER, ELECTRICIAN, ETC.) LICENSING AUTHORITY EXPIRATION DATE
______________________________________________________________________________________________________________________________________________________________________________________________________________________
_
_____________________________________________________________________________________________________________________________________________________________________________________________________________________
PLEASE INDICATE ANY OTHER EXPERIENCE OR SKILLS YOU HAVE GAINED THROUGH PROFESSIONAL ORGANIZATIONS OR VOLUNTEER WORK.
Do you have a current legal driver’s license? yes no (If yes, indicate class)
1. car or light truck
2. commercial driver’s license class ____________________ endorsement/restriction _______________________________________________________________________________
References
List three persons who are not related to you and have knowledge of your qualifications.
I certify that the information on this application is true and complete. I understand that any misrepresentation or omission of facts may be considered cause for rejection of my application or
termination of employment. I understand that nothing contained in this application or in the granting of an interview is intended to create an employment contract between Daemen College
and myself for either employment or the provision of any benefit. No promises regarding employment have been made to me. If an employment relationship is established, I understand that
I have the right to terminate my employment at any time and that Daemen College retains a similar right.
I HEREBY AUTHORIZE ANY PERSON OR PERSONS, TO GIVE DAEMEN COLLEGE REPRESENTATIVES ANY INFORMATION ABOUT ME, AND RELEASE THEM FROM
ANY LIABILITY FOR SO DOING.
Signature _____________________________________________________________ Date ______________________________________________________________________
12/2019
click to sign
signature
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