PEKO
   
           
 
           
 
  Application For Employment
       
   
  Personal    
       
  First Name  
  Middle name  
  Last Name  
  Street Address  
  City, State, Zip  
  Home Phone  
  Business Phone  
  Soc. Sec. #   - -
  Positions Applied For  
  Who referred you  
  to our company?  
     
       
  Are you of legal age to work?   Yes
      No
  To the best of your knowledge,  
  you are legally eligible to work   No
  in the United States?  
  Date you are available to start work:   / /
  Salary or wages desired   $ / Hr Week
  What type of employment are   Full Time
  you applying for?   Part Time
      Night
      Shift
      Temporary
  If you are applying for Part Time, Night, Shift or temporary employment, please specify days and hours you are available:
NOTE: Every consideration will be given to work availability information provided by an applicant; however, there is no guarantee
the Company can offer employment that accomodates applicants' availability to work.		  
Mon AM PM to AM PM
Tues AM PM to AM PM
Weds AM PM to AM PM
Thurs AM PM to AM PM
Fri AM PM to AM PM
Sat AM PM to AM PM
  Have you ever applied for work   Yes
  here before?   No
  If YES, enter date here: / /
  Were you ever employed by us   Yes
  before?   No
  If YES, enter date here: / /
  If you are applying for Full Time   Yes
  employment, can you work overtime   No
  if necessary?    
  Are you employed at the present   No
  time?   Yes
      If YES, can we contact your present employer?
      Yes
      No
  Do you have any relatives now   No
  employed by this Company?   Yes
      If YES, please list names(s) and department:
     
        Name   Department    
  Have you ever been bonded in   Yes
  prior employment?   No
      If YES, list name(s) of employer(s):
  Have you ever been convicted of a   Yes
  crime (excluding misdemeanors and   No
  traffic offenses)?   If YES, list convictions:
      (a conviction does not necessarily disqualify an applicant for the position being applied for).
  Education    
       
  High School    
  Name  
  Location  
  Number of years completed:  
  Did you graduate?   Yes
      No
  What was your course of study?   Academic
      Business
      Trade of Technical
      Other
  College    
  Name  
  Location  
  Number of years completed:  
  Did you graduate?   Yes
      No
  What was your major?  
  Degree:  
  Did you enroll in a post-graduate course   Yes
  of education?   No
      If "Yes", what was your post-graduate field of study?
     
      Degree:
  Trade, Business or Correspondence School
  Name  
  Location  
  Number of years completed:  
  Did you graduate?   Yes
      No
  What was your course of training or  
  study?    
  Special Qualifications or Skills
  Use this space to describe any special  
  qualifications or skills you have  
  acquired.  
  If computer skills are required for the   PC
  job position you have applied for,   Mac
  please check the boxes that apply to   Both
  your experience:    
  Software applications:  
Word Processing Presentation
Accounting E-mail
Data Processing Internet
Graphics Other
  Foreign Languages    
  Indicate foreign language(s) you are familiar with:    
  Language:  
Fluent Speak
Good Read
Fair Write
  Language:  
Fluent Speak
Good Read
Fair Write
  Memberships    
  List Business, Trade, Professional,  
  Community or Activities Memberships  
  and any offices you may have held.  
  (Exclude any Organizations the name and  
  character of which would reveal race, religion,    
  national origin or any other protected status):    
 
  Prior Employment    
  (Start with most recent employer)    
  Employer  
  Address  
  City, State, Zip  
  Phone Number  
  From   / /
  To   / /
  Supervisor's Name  
  Starting Salary/Wages  
  Final Salary/Wages  
  Reason for Leaving  
  Employer  
  Address  
  City, State, Zip  
  Phone Number  
  From   / /
  To   / /
  Supervisor's Name  
  Starting Salary/Wages  
  Final Salary/Wages  
  Reason for Leaving  
  Employer  
  Address  
  City, State, Zip  
  Phone Number  
  From   / /
  To   / /
  Supervisor's Name  
  Starting Salary/Wages  
  Final Salary/Wages  
  Reason for Leaving  
  Employer  
  Address  
  City, State, Zip  
  Phone Number  
  From (MM/DD/YYYY)   / /
  To (MM/DD/YYYY)   / /
  Supervisor's Name  
  Starting Salary/Wages  
  Final Salary/Wages  
  Reason for Leaving  
  Military Service    
       
  Were you a member of the U.S.   Yes
  Armed Forces?   No
  Branch:  
  Describe briefly your military duties:  
     
     
  Years served:   -
  Rank at discharge:  
  Personal References    
  List three personal references.    
  (exclude relatives or former employers)    
  Name  
  Address  
  Telephone  
  Name  
  Address  
  Telephone  
  Name  
  Address  
  Telephone  
       
 
Applicant's Statement

The information provided by me in this application for employment is true and complete to the best of my knowledge. Should I be employed by the Company, any misrepresentation or any false statement contained herein may be considered cause for possible dismissal.

The Company, in compliance with the provisions of the Fair Credit Reporting Act of Sept. 1997, may contact directly or employ the services of investigative agencies to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history or credit standing. I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the Company.

I understand this application does not constitute an employment contract of any kind. Should I be employed by the Company, I may resign such employment at any time at my discretion with or without prior notice and the Company may terminate my employment at any time at their discretion, with or without cause and with or without prior notice.

This application will be considered valid for a period of 60 days. After 60 days it will be necessary for me to submit a new application.
  Signature of Applicant (Initials)  
  Date (MM/DD/YYYY)  
       
     

 
 

 

        
 

 

   
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