SEMICONIX
CORPORATION
Re:
Date:

To:
Message:

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION
FIRST NAME*
MIDDLE NAME
LAST NAME*
SSN
PRESENT ADDRESS*
MAILING ADDRESS*
TELEPHONE #*
CELL PHONE #
E-MAIL*
Related to anyone in our employ (state name and department) YES No
REFERRED BY

EMPLOYMENT DESIRED
POSITION*
DATE YOU CAN START
SALARY DESIRED*
ARE YOU EMPLOYED NOW? Yes No
IF YES, WHY ARE YOU CONSIDERING CHANGING JOBS?
HAVE YOU EVER APPLIED WITH US BEFORE? Yes No
WHEN?

EDUCATION NAME AND LOCATION OF SCHOOL NO. OF YEARS ATTENDED DID YOU GRADUATE? SUBJECTS STUDIED
GRAMMAR SCHOOL Yes No
HIGH SCHOOL Yes No
COLLEGE Yes No
TRADE, BUSINESS SCHOOL Yes No
SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK
WHAT FOREIGN LANGUAGES DO YOU SPEAK FLUENTLY? READ WRITE

FORMER EMPLOYERS
(LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)
DATE, MONTH AND YEAR
( From - To)
NAME AND ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING

REFERENCES
GIVE BELOW THE NAME OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR
NAME ADDRESS COMPANY YEARS ACQUAINTED

EMERGENCY NOTIFICATION
NAME
ADDRESS
TELEPHONE #

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION, I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL. FURTHER I UNDERSTAND AND I AGREE THAT MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PREVIOUS NOTICE.
I Agree I Do Not Agree

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SEMICONIX CORPORATION
SEMICONIX CORPORATION
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