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Employment Applications

Town of White Hall

118 Tygart Mall Loop

White Hall, WV 26554

Employment Application

EMPLOYMENT APPLICATION

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APPLICANT INFORMATION

Name:

Date:

Address:

Phone:

Email:

Date Available:

Social Security Number:

Desired Salary:

Position applied for:

Are You a U.S. citizen?

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

If yes, when?

Have you ever been convicted of a felony?

Yes

No

If yes, explain:

Have you ever worked for this company?

Yes

No

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EDUCATION

High School:

Address:

From:

To:

Did you graduate?

Yes

No

College:

Address:

From:

To:

Did you graduate?

Yes

No

Degree:

Other:

Address:

From:

To:

Did you graduate?

Yes

No

Degree:

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REFERENCES - Please list three

Reference Name:

Relationship:

Company:

Phone:

Address:

Reference Name:

Relationship:

Company:

Phone:

Address:

Reference Name:

Relationship:

Company:

Phone:

Address:

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PREVIOUS EMPLOYMENT

Previous Employer:

Phone:

Address:

Job Title:

Starting Salary:

Ending Salary:

Responsibilties

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference?

Yes

No

Previous Employer:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilties:

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference?

Yes

No

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MILITARY SERVICE

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, please explain:

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DISCLAIMER & ACKNOWLEDGEMENT

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my apllication or interview may result in my release.

Acknowledgement:

Date:

Thank you for contacting us.
We will get back to you as soon as possible.

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Contact Info

Phone: (304) 367-1687

Fax: (304) 367-1020

118 Tygart Mall Loop,

White Hall WV 26554

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