PANCIUTO
Application for Employment
Please print, complete and mail to: Panciuto, 110 S. Churton Street, Hillsborough, NC 27278
Personal Information
Date: _______________________
Name:__________________________________________ SSN: ________________________
Present Address: ________________________________________________________________________
Email address: _________________________________________________________________________
Telephone: _____________________ Position Applied For: ________________________________
Are you legally eligible for employment in the USA? ______ Age if under 18: _______________
Rate of pay expected: __________________ Do you want full or part time: __________________
Specify day and hours available to work: _____________________________________________________
When are you available to begin work: ______________________________________________________
List your qualifications, skills, and experience that will be an asset to Panciuto and the position you which you are
applying:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Record of Education
High School: ___________________________________________ Did you graduate: _____________
College: _______________________________________________ Course of study: ______________
Did you graduate: __________ If not, what was the last year completed: _________________
Other educational studies relevant to your application: __________________________________________
Personal References
Please list three personal references, their names, occupations, addresses and phone numbers:
1. _______________________________________________________________________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
List all present and past employment beginning with your most recent
Name and address of company: ____________________________________________________________
Telephone: _________________________ Dates of employment: ________________________
Supervisor: _________________________ Start and end salary: __________________________
Reason for leaving: _______________________________________________________________
Describe the work you do/did:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Name and address of company: ____________________________________________________________
Telephone: _________________________ Dates of employment: ________________________
Supervisor: _________________________ Start and end salary: __________________________
Reason for leaving: _______________________________________________________________
Describe the work you do/did: ______________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Name and address of company: ____________________________________________________________
Telephone: _________________________ Dates of employment: ________________________
Supervisor: _________________________ Start and end salary: __________________________
Reason for leaving: _______________________________________________________________
Describe the work you do/did: ______________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
May we contact the employers listed above: ____ If not, please specify the ones you do NOT wish us to
contact : _____________________________________________________________________________