Charlotte Sound & Visual Systems, Inc

Applicant Information

Last Name

First

M.I.

Date

Street Address

Apartment/Unit #

City

State

ZIP

Phone

E-mail Address

Date Available

Social Security No.

Desired Salary

Position Applied for:

Are you a citizen of the United States?

YES 

NO 

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

YES 

NO 

Have you ever worked for this company?

YES  

NO  

If so, when?

Have you ever been convicted of a felony?

YES  

NO  

If yes, explain

Education

HIGH SCHOOL

COLLEGE

     Number of Years Completed:   1          2          3          4

Number of years Completed:  1          2          3          4

     Did You Graduate?    Yes             No       GED? ________

           Degree Earned:

NAME AND ADDRESS OF SCHOOL (CITY & STATE)

NAME AND ADDRESS OF SCHOOL (CITY & STATE)

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?

YES 

NO 

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?

YES 

NO 

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?

YES 

NO 

Military Service

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

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 application or interview may result in my release.  I authorize Charlotte Sound & Visual Systems to investigate, without liability, all statements contained in this application.  I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment.  If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment.  I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment.  This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Signature

Date