GeoSurvey, Ltd.
APPLICATION FOR EMPLOYMENT


Each inquiry on this application must be fully answered or completed

Position Desired: 

If offered this position when would you be able to start?

How were you referred to us?



------ PERSONAL DATA -------

First Name:    Middle Initial:    Last Name:    

Email Address:

Social Security Number: 
 

Present Address:


City, State  Zip:
,                                                       

How long have lived there?    yrs:  months:

Telephone Number:                 

 Are you 18 years or older?   Yes     No       

If hired, can you provide proof that you are legally entitled to work in the U.S. ?    Yes No

Have you filed an application here before?   Yes No
If Yes, give dates: 

Have you ever worked for this Company before?  Yes    No       
 If Yes, give dates & position:                                             

Do you have any friends or relatives working here?  Yes    No       
 If Yes, name: 

Do you have adequate transportation to and from work?  Yes    No

Have you ever pleaded guilty or “no contest” to a crime or been convicted of a crime? 
Yes    No

If Yes, please give dates and details of each:
 

NOTE: Answering “Yes” to the previous question does not constitute an automatic bar to employment.





------ EDUCATION AND EXPERIENCE -------

 

Elementary

High

College/University

Graduate/Professional

School Name





Years Completed



 4     5      6      7     8



9    10   11   12

   

1     2     3     4

 

1      2     3     4

Diploma/Degree


 


 


Describe Course of Study or Major


 

 

 

Describe Specialized Training, Military Experience, Skills, and Extra-Curricular Activities

 

 

 



In order to permit a check of your work and educational records, should we be made aware of any change in name or assumed name that you previously used?  Yes    No  
If Yes, identify name and relevant dates.

                                                                              


Please describe any other experience that you have which would be relevant to the job for which you are applying:

                                                                                                                                                                       

Are you capable of satisfactorily performing the essential job duties with reasonable accommodation required of the position for which you are applying?  Yes    No





 --------- RECORD OF PREVIOUS EMPLOYMENT -----------

Please list the names of your previous employers in chronological order with present or last employer first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references.

Name of Present or Last Employer



Address



City, State, Zip



Telephone:

Employed  From (mo/yr)    To (mo/yr)

Starting pay  $     Final pay  $

Your Title or Position

Name of Last Supervisor

Major Job Duties



Reason for Leaving


Previous Employer



Address



City, State, Zip



Telephone:

Employed  From (mo/yr)    To (mo/yr)

Starting pay  $     Final pay  $

Your Title or Position

Name of Last Supervisor

Major Job Duties



Reason for Leaving


Previous Employer



Address



City, State, Zip



Telephone:

Employed  From (mo/yr)    To (mo/yr)

Starting pay  $     Final pay  $

Your Title or Position

Name of Last Supervisor

Major Job Duties



Reason for Leaving


Previous Employer



Address



City, State, Zip



Telephone:

Employed  From (mo/yr)    To (mo/yr)

Starting pay  $     Final pay  $

Your Title or Position

Name of Last Supervisor

Major Job Duties



Reason for Leaving


Previous Employer



Address



City, State, Zip



Telephone:

Employed  From (mo/yr)    To (mo/yr)

Starting pay  $     Final pay  $

Your Title or Position

Name of Last Supervisor

Major Job Duties



Reason for Leaving

Are you now employed?  Yes No    
Are you on layoff? Yes No    
Are you subject to recall?
  Yes No

Do you have any commitments to any other employer which may affect your employment?
Yes     No
If Yes, please explain: 


Have you ever been terminated or asked to resign from any job?  Yes  
If Yes, please explain circumstances:


Please explain fully any gaps in your employment history:


May we contact your current employer?  Yes No  
If No, please explain:







---------- CHARACTER REFERENCES ------------

Please list persons who know you well – Not previous employers or relatives

Name Occupation Address Street
City, State and Zip
Telephone Number Years Known











---------- DRIVING INFORMATION ------------

[Complete only if you are applying for a position in which you will drive a vehicle (Company or Personal) in connection with your employment]

Do you have a current valid driver’s license?   Yes No

If Yes, License #         
State:       Expiration Date:            


Has your license ever been suspended or revoked?   Yes
If Yes, please explain:


Please list all moving traffic violations in the last five (5) years. Please include the Offense, Date, Location, and any Comments:

NOTICE TO ALL APPLICANTS:

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF THIRTY (30) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.

By checking this box, you have read and understood the terms of the Application Agreement.