Employment Application for Northcore USA

    (Pre-Employment Questionnaire - Equal Opportunity Employer)

    Personal Information

    First Name:

    Middle Name:

    Last Name:

    Present Address

    Street:

    City:

    State:

    Zip:

    Permanent Address

    Street:

    City:

    State:

    Zip:

    Your Email:

    Your Phone Number:

    Are you 18 years or older?

    Employment Desired

    Desired Position:

    Date You Can Start:

    Salary Desired:

    Are you employed now?

    If so, may we contact them?

    Have you ever applied with us before?

    When:

    Where:

    Referred By:

    Education
    Grammar School

    Name / Location of School:

    Years Attended:

    Did You Graduate:

    Subjects Studied:

    High School

    Name / Location of School:

    Years Attended:

    Did You Graduate:

    Subjects Studied:

    College

    Name / Location of School:

    Years Attended:

    Did You Graduate:

    Subjects Studied:

    Trade / Business School

    Name / Location of School:

    Years Attended:

    Did You Graduate:

    Subjects Studied:

    General Information

    Subjects of special study or research work:

    Special skills:

    Activities (Civil Athletics, etc.):

    US Military or Naval Service:

    Your Rank:

    Present membership in National Guard or Reserves?:

    Employment
    Employer One

    Name & Address of Employer:

    Date Started:

    Date Ended:

    Salary:

    Position:

    Reason for Leaving:

    Employer Two

    Name & Address of Employer:

    Date Started:

    Date Ended:

    Salary:

    Position:

    Reason for Leaving:

    Employer Three

    Name & Address of Employer:

    Date Started:

    Date Ended:

    Salary:

    Position:

    Reason for Leaving:

    Which of these jobs did you like best?

    What did you like most about this job?

    References
    Reference One

    Name:

    Phone:

    Job:

    Years Known:

    Reference Two

    Name:

    Phone:

    Job:

    Years Known:

    Reference Three

    Name:

    Phone:

    Job:

    Years Known:

    Emergency Contact
    In case of emergency, please notify:

    Name:

    Address:

    Phone:

    Any Comments?

    I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed. My employment may be terminated at any time.

    In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause. And with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president or general manager, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

    Your Signature:
    (Please sign with your mouse or finger.)