Form


Boston Stoker is an Equal Opportunity Employer
Applicant Information
Name: *
E-mail: *
Telephone Number: *
Address: *
Applying for Position:
When can you start?
Desired Salary:
Type of Employment Seeking: *	Full Time Part Time Seasonal
Locations Available to work" *	Airport Englewood Downtown Dayton Brown St. Centerville Oakwood DLM Washington SQ DLM Springboro DLM
Hours Available: *
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 yes, when?
Are you 18 years of age or older? *	YES NO
Have you ever been convicted of a felony? *	YES NO
If yes, explain
Education
High School:
Address:
From:
To:
Did you graduate?	YES NO
Degree:
...
College:
Address:
From:
To:
To:
Did you graduate?	YES NO
Degree:
...
Other:
Address:
From:
To:
Did you graduate?	YES NO
References
Please list three professional references (do not list family members).
Full Name: *
Relationship: *
Company: *
Phone Number: *
Address: *
...
Full Name: *
Relationship: *
Company: *
Phone Number: *
Address: *
...
Full Name: *
Relationship: *
Company: *
Phone Number: *
Address: *
Previous Employment
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason for leaving:
May wae contct 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 wae contct your previous supervisor for a reference?	YES NO
...
Company:
Phone Number:
Address:
Supervisor:
Job Title:
Starting Salary;
Ending Salary:
Responsibilities:
From:
To:
Reason for leaving:
May wae contct 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 hereby authorize Boston Stoker, Inc to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment. I authorize schools, persons, my current and past employers and organizations contacted by Boston Stoker, Inc to provide any relevant information regarding my current and/or previous employment. I release all schools, persons, and employers of any and all claims for providing such information. I understand that misrepresentation or omission of facts may result in rejection of this application or if hired discipline up to and including dismissal. I understand that I may be required to sign a confidentiality and/or non-compete agreement, should I become an employee of Boston Stoker, Inc. I understand that nothing contained in this application or conveyed during any interview which may be granted, is intended to create an employment contract. I understand that filling out this form does not indicate there is a position open and does not obligate Boston Stoker, Inc to hire me. I understand and agree that my employment is at will, which means that it is for no specified period and may be terminated by me or Boston Stoker, Inc at any time without prior notice for any reason.
Type Name to Sign: *
Date: *
*