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: ________________________________________________________________________
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 : _____________________________________________________________________________
Email: __________________________________________
