Ed Wyse & Company, Inc.

PO Box 3665 Seattle WA 98124

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, handicap or national origin.

Name: Social Security #:
Present Address: Phone Number:
Permanent Address: Phone Number:
Referred By : Position Applied For:
Are you at least 18 years of age?
yes    no
  

Have you been convicted of a felony in the last 7 years?

If so, explain:

 

(a "yes" answer will not necessarily bar an applicant from employment)
yes    no
Are you a US citizen or legally authorized to work in the US?
yes    no
  
Date you are able to start work:
May we contact your current employer?
yes    no
Are you on layoff status or subject to recall elsewhere?
yes    no
  

Have you previously applied with us?  

If yes, when?
yes    no
Pay expected: $
 

Have you previously worked for us?  

If yes, when?
yes    no

If hired, how long do you plan to continue working for this company?  

o Long term      o Temporary     How Long?

  

Are any of your records under another name?  

If so, what name?
yes    no

Do you wish to work:  

o Full Time      o Part Time      o Temporary

  

Do you have any relatives working for us ?  

If so, who?
yes    no

Are you willing and able to work :  

o Days    o Evenings    o Overtime    o Weekends

 

Is there any reason you might not be able to meet our attendance requirements ?

If yes, please explain:

yes    no
Are you or have you ever been bonded?
yes    no
  
EDUCATION
NAME & LOCATION OF SCHOOL
DID YOU GRADUATE? SUBJECTS STUDIED
HIGH SCHOOL .
yes    no
 .
COLLEGE .
yes    no
 .
OTHER TRAINING .
yes    no
 .
Are you taking or do you plan to take any additional education? If so, what?
SKILLS / ABILITIES: List subjects of special study or research work:
JOB RELATED SKILLS ( typing, driver's license, etc.)
Present or last employer: Supervisor: Rate of pay:
Address and Phone: Starting Date: Leaving Date:
Job Duties:
Why did you leave?
Previous employer: Supervisor: Rate of pay:
Address and Phone: Starting Date: Leaving Date:
Job Duties:
Why did you leave?
Previous employer: Supervisor: Rate of pay:
Address and Phone: Starting Date: Leaving Date:
Job Duties:
Why did you leave?

PERSONAL REFERENCES

List below two people not related to you whom you have known at least one year

Name: Phone:
Address:
Occupation: How long known:
Name: Phone:
Address:
Occupation: How long known:
 
In case of emergency notify: Phone:
Address:
  • If a job offer is made, it may be contingent upon the successful passing of a physical which may include screening for illegal drugs.
  • I CERTIFY that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, false, misleading or incomplete statements on this application shall be grounds for dismissal.
  • I AUTHORIZE the company to investigate information concerning my previous employment and education. I further authorize those persons and companies referenced above to provide information to you, and hereby release such parties from all liability for any damage that may result from furnishing such information.
  • I UNDERSTAND that all company property must be returned and any indebtedness to the company must be paid on or before my last day of work. I authorize the company to deduct from my final paycheck an amount necessary to satisfy any unpaid obligation.
Date: Signature of Applicant :