Application for Employment

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We are an Equal Opportunity Employer. PERSONAL INFORMATION: Name (First, Middle, Last): Street: City: State: Zip: Daytime Phone: Evening Phone: Email: Have you ever applied for employment with us? Yes No Are you legally eligible for employment in the United States? Yes No Are you 18 years of age or older? Yes No EMPLOYMENT DESIRED: Position for which you are applying: Specific Available Hours: Salary Required: Date you can start: Are you available to work overtime? Yes   No Have you ever worked for JB Zimmerman? Yes *   No * If yes, when?: Apart from absence for religious observance, are you available for full-time work? Yes   No * * If not, what hours can you work?: EDUCATION: Elementary: Name of School Location of School # of Years Attended Did you Graduate Yes   No Subjects Studied/Degrees Received High School: Name of School Location of School # of Years Attended Did you Graduate Yes   No Subjects Studied/Degrees Received Trade, Business, Technical School Name of School Location of School # of Years Attended Did you Graduate Yes   No Subjects Studied/Degrees Received College Name of School Location of School # of Years Attended Did you Graduate Yes   No Subjects Studied/Degrees Received Graduate Name of School Location of School # of Years Attended Did you Graduate Yes   No Subjects Studied/Degrees Received EMPLOYMENT HISTORY: Please List your last 3 employers, starting with the most recent: Most Recent Employer Name of Employer: Address: Dates of Employment: From to Salary/Wage: Position: Reason for Leaving: Duties Performed: Supervisor's Name and Phone Number: May We Contact? Yes   No Previous Employer Name of Employer: Address: Dates of Employment: From to Salary/Wage: Position: Reason for Leaving: Duties Performed: Supervisor's Name and Phone Number: May We Contact? Yes   No Previous Employer Name of Employer: Address: Dates of Employment: From to Salary/Wage: Position: Reason for Leaving: Duties Performed: Supervisor's Name and Phone Number: May We Contact? Yes   No J.B. Zimmerman & Sons, Inc. Box 337 Blue Ball, PA 17506 The information provided in this Application for Employment is true, correct and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. If you decide to engage an investigative consumer reporting agency to report on my credit and personal history I authorize you to do so. If a report is obtained you must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report. Name/Signature:    Date:   3/10/2010 Verify: In order to minimize abuse/spam, please enter the text you see into the input field below. The text is numbers only. Enter the 4 digit number as shown: