EBZ Moving & Storage - Application for Employment

Applicant Information:

Name		Social Security Number
Phone Number		Referred by

Present Address:

Address
City / State / Zip

Permanent Address:

Address
City / State / Zip

Employment Desired:

Position

Earliest Start

Salary Desired

/ hour

Are You Currently Employed?

Yes No

If so, may we contact your current employer?

Yes No

Prior Employment History:

Please provide us with some information on your last two places of Employment

Most Recent Employer:

Company Name
Address
City / State / Zip

Dates of Employment:

From: /
To: /

Position
Salary	/ hour

Reason for
Leaving:

Previous Employer:

Company Name
Address
City / State / Zip

Dates of Employment:

From: /
To: /

Position
Salary	/ hour

Reason for
Leaving:

References:

Please list three people as references, not related to you, that you have known over a year

Name

1.
2.
3.

Address

How Known

Years
Known

Authorization

By submitting this application, you authorize EBZ Moving & Storage to investigate all statements contained herein; to contact the individuals listed above concerning any pertinent information they may have; and release EBZ Moving & Storage from any liability or damages that may result from the use of that information.

When interviewed, you will be asked to sign a copy of this application and acknowlege that to the best of your knowledge that all of the information you have provided on this application is true and complete. If employed, falsified statements on this application shall be considered grounds for dismissal.

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