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Employment Application

Name

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/ week


I can be scheduled to work these hours:

Sunday

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Monday

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Tuesday

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Wednesday

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Thursday

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Friday

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Saturday

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Rate Yourself

Please Rate Yourself on the Following:

(1) Not good  (2) Fair  (3) Average  (4) Good  (5) Excellent

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Employment History (begin with most recent position)

Dates of Employment:

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Dates of Employment:

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Dates of Employment:

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References

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I certify that my answers are true and complete to the best of my knowledge. I authorize Northland Rolladium to make such investigations and inquiries of my personal employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application. In the event I am employed, I understand that false or misleading information given in my application may result in termination of employment.