Sager Metal Strip Company

Name
Street Address
City
State
Zip
E-mail
Telephone Number
Referred By

Position
Salary Desired

Date You Can Start: Mo/Day/Yr

Are you currently employed? Yes No
If so, may we inquire of your present employer? Yes No

Have you ever filled an application with us before? Yes No
Where?		When?

Grade School:
Middle School:
High School: Year Completed: Diploma Received?	YES NO
College: Year Completed: Diploma/Degree:
Trade, Business or Correspondence School: Year Completed: Diploma/Degree:

Subjects of Special Study/Research Work or Special Training/Skills

U.S. Military or Naval Service? Yes No
Rank

Former Employers
(List Below Last Four Employers, Starting With The Last One First)

Employer #1

From

Address

Salary

Position

Reason for Leaving

Employer #2

From

Address

Salary

Position

Reason for Leaving

Employer #3

From

Address

Salary

Position

Reason for Leaving

Employer #4

From

Address

Salary

Position

Reason for Leaving

References
(Give Below The Names Of Three Persons Not Related To You, Whom You Have Known At Least One Year)

Reference #1
Address
Business
Years Known

Reference #2
Address
Business
Years Known

Reference #3
Address
Business
Years Known

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on the application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my pervious employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release of use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Signature (Check box, if you agree with the above statement)

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