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
