Employment App - Herlihy Moving & Storage

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    Employment App

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    Employment Application

    Applicant Information

    Last:

    First:

    M.I.:

    DOB:

    Phone:

    Email:

    Street Address:

    Apartment/Unit #:

    City:

    State:

    ZIP Code:

    Date Available:

    Desired Salary:

    Position Applied for:

    Are you a citizen of the United States?

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

    Have you ever worked for this company?

    If you've worked for company, when?

    Have you ever been convicted of a felony?

    If yes, explain:

    Education

    High School:

    Address:

    From:

    To:

    Did you graduate?

    Diploma:

    College:

    Address:

    From:

    To:

    Did you graduate?

    Degree:

    Other:

    Address:

    From:

    To:

    Did you graduate?

    Degree:

    References

    Please list three professional references.

    Full Name:

    Relationship:

    Company:

    Phone:

    Address:

    Full Name:

    Relationship:

    Company:

    Phone:

    Address:

    Full Name:

    Relationship:

    Company:

    Phone:

    Address:

    Previous Employment

    Company:

    Phone:

    Address:

    Supervisor:

    Job Title:

    Starting Salary:

    Ending Salary:

    Responsibilities:

    From:

    To:

    Reason for Leaving:

    May we contact your previous supervisor for a reference?

    Company:

    Phone:

    Address:

    Supervisor:

    Job Title:

    Starting Salary:

    Ending Salary:

    Responsibilities:

    From:

    To:

    Reason for Leaving:

    May we contact your previous supervisor for a reference?

    Company:

    Phone:

    Address:

    Supervisor:

    Job Title:

    Starting Salary:

    Ending Salary:

    Responsibilities:

    From:

    To:

    Reason for Leaving:

    May we contact your previous supervisor for a reference?

    Military Service

    Branch:

    From:

    To:

    Rank at Discharge:

    Type of Discharge:

    If other than honorable, explain:

    Experience

    Forklift Driving

    Packing

    Straight Truck Driving

    Roll Back Truck Driving

    Household Moving

    Inventory

    Commercial Moving

    Semi-Truck Driving

    Disclaimer and Signature

    I affirm that all of the information provided in this employment application is true and complete to the best of my knowledge. I authorize the investigation of any or all statements contained in this application and also authorize any person, educational institution, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision, including a criminal background check. I release such persons and organizations from any legal liability in making such statements. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in immediate termination of my employment if discovered at a later date.

    This information is provided solely for the purpose of conducting a background check. I have read and understand the above statements. I affirm the above statements to be true.

    Signature:

    Date: