Monarch Enterprises
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Application For Employment

Position Applying For

Personal Information
First Name
Middle Name
Last Name
Alternate Name	NOTE: If you are known by another name to past employers or schools, please list name (include maiden name, nickname, etc)
Address 1
Address 2
City
State
Zip Code
Telephone #
Mobile/Beeper/Other Phone #
Social Security #
E-mail Address
Referral Source	Advertisement Employee Relative Government/Private Employment Agency Walk-in Other: Name of source:
If necessary, best time to call you at home is
May we contact you at work?	Yes No If yes, work number: Best time to call:
If you are under 18 and it is required, can you furnish a work permit?	Yes No If no, please explain:
Have you submitted an application here before?	Yes No If yes, give date(s) and position(s)
Have you ever been employed here before?	Yes No If yes, give dates:
Are you eligible for employment in this country?	Yes No
Date available to start
What is your desired salary range?
Desired work hours	Days Evenings Nights
Availability	Full Time Part Time On Call Seasonal Weekends
Will you work overtime if required?	Yes No
Have you ever been convicted of a misdemeanor or felony, in any jurisdiction? Yes No (A conviction will not automatically disqualify an applicant for the position being applied for) Are there criminal charges pending against you? Yes No If you answered yes to either of the last two questions, please provide date(s) and details list the specific nature of the crims(s), date(s), court location, sentencing information, disposition of sentence, or pending charges. (The agency reserves the right to reject individuals for employment regarding job-related convictions.)
Do you have a valid NYS Driver's License?	Yes No License Number:
Has you Driver's License ever been suspended or revoked?	Yes No
Have you been convicted of any moving violations or occurrences involving harm to human beings or property while driving?	Yes No
Have you ever been convicted of DWI, DWUI or DWAI?	Yes No
Do you currently have seven or more points against your driver's license?	Yes No
How many years have you been a licensed driver?
ANSWERING ï¿½YESï¿½ TO THESE QUESTIONS DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT.

Employment PLEASE DO NOT LEAVE ANY BLANK SPACES OR REFER TO RESUME Provide the following information of your past and current employers, assignments or volunteer activities, starting with the most recent (use additional sheets if necessary). Explain any gaps in employment in the comment section below.
Employer 1
Employer Name
Address
City
State
Zip
Telephone
Employed From	(mm/yy)
Employed To	(mm/yy)
Wage	per
Immediate supervisor for reference purposes and their title
Reason for leaving
Your Title & Duties
Employer 2
Employer Name
Address
City
State
Zip
Telephone
Employed From	(mm/yy)
Employed To	(mm/yy)
Wage	per
Immediate supervisor for reference purposes and their title
Reason for leaving
Your Title & Duties
Employer 3
Employer Name
Address
City
State
Zip
Telephone
Employed From	(mm/yy)
Employed To	(mm/yy)
Wage	per
Immediate supervisor for reference purposes and their title
Reason for leaving
Your Title & Duties
Employer 4
Employer Name
Address
City
State
Zip
Telephone
Employed From	(mm/yy)
Employed To	(mm/yy)
Wage	per
Immediate supervisor for reference purposes and their title
Reason for leaving
Your Title & Duties
Employer 5
Employer Name
Address
City
State
Zip
Telephone
Employed From	(mm/yy)
Employed To	(mm/yy)
Wage	per
Immediate supervisor for reference purposes and their title
Reason for leaving
Your Title & Duties
Employer 6
Employer Name
Address
City
State
Zip
Telephone
Employed From	(mm/yy)
Employed To	(mm/yy)
Wage	per
Immediate supervisor for reference purposes and their title
Reason for leaving
Your Title & Duties
Employer 7
Employer Name
Address
City
State
Zip
Telephone
Employed From	(mm/yy)
Employed To	(mm/yy)
Wage	per
Immediate supervisor for reference purposes and their title
Reason for leaving
Your Title & Duties
Employer 8
Employer Name
Address
City
State
Zip
Telephone
Employed From	(mm/yy)
Employed To	(mm/yy)
Wage	per
Immediate supervisor for reference purposes and their title
Reason for leaving
Your Title & Duties
Employer 9
Employer Name
Address
City
State
Zip
Telephone
Employed From	(mm/yy)
Employed To	(mm/yy)
Wage	per
Immediate supervisor for reference purposes and their title
Reason for leaving
Your Title & Duties
Employer 10
Employer Name
Address
City
State

Application For Employment

Position Applying For

Personal Information

Employment