BMIC - Careers

APPLICATION FOR EMPLOYMENT

Date of Application:

Position(s) Applied for:

Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, age, sex, handicap, disability, veteran status, marital status, sexual orientation or any other characteristic protected by law. WE ARE AN EQUAL OPPORTUNITY EMPLOYER.

PERSONAL

First Name

M.I.

Last Name

Other Name(s) Used in School or Employment

Street Address

City

State

Zip

Telephone (Day)
( ) -

Telephone (Evening)
( ) -

Social Security Number
- -

Employment Desired

If Other, please specify

Source Referred

If Other, please specify

EMPLOYMENT HISTORY

May we contact your present employer?

Start with most recent position. Please account for all periods of employment, self employment, and unemployment in the last ten years

Employer	Employed From	Employed to	Description of Duties
Address/City/State/ZIP Code		Supervisor
Telephone ( ) -	Salary	Reason for Leaving

Employer	Employed From	Employed to	Description of Duties
Address/City/State/ZIP Code		Supervisor
Telephone ( ) -	Salary	Reason for Leaving

Employer	Employed From	Employed to	Description of Duties
Address/City/State/ZIP Code		Supervisor
Telephone ( ) -	Salary	Reason for Leaving

EDUCATION

	Name and Address of School		Major Course	Diploma or Degree
High School
College
Business or Trade School or Special Training		# of months attended

MORE INFORMATION

Are you at least 18 years of age?

Have you ever been convicted of a crime? (A conviction does not automatically bar you from employment.)

If yes, describe in detail:

Are you legally permitted to work in the U.S.? (Proof required upon hire.)

What knowledge, special technical or computer skills and/or individual capabilities do you have which
especially prepare you for the position you have applied for?

List any other skills you wish to mention:

Typing or keystroke speed:

If hired, when would you be available?

Salary Requirement:

REFERENCES

Name of Reference	Name of Reference
Occupation	Occupation
Address	Address
City/State/ZIP	City/State/ZIP
Telephone ( ) -	Telephone ( ) -

I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind. I agree that the company shall not be held liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may be cause for termination. I understand that a medical examination based on the requirements of the position for which I am being considered may be required and drug testing may also be required. I also authorize the companies, schools or persons named herein to give any information requested regarding my employment, character and qualifications. I hereby release said companies, schools or persons from all liability for any damage for issuing this information. I understand and acknowledge that if I am hired, my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either my employer or myself.