Personal Information
Last Name Personal Address
First Name Phone:
Social Security NO: Cellular:
Marital Status: Nationality:
Date of Birth: D/M/Y Age:
Desired Employment
Position: Salary Desired (Weekly):
Date You Can Start: Full Time: ⬜ Part Time: ⬜
Are You Willing To Do Overtime?
Do You Possess A Valid Drivers License?
List The Class That You Are Able To Drive:
Can You Operate Any Type Of Machinery?
List Knowledge Of Any Computer Program You Are Familiar With:
Education
Schools Attended: Dates Attended Degree Concentration
Primary:
Secondary:
College:
Trade School:
References (References From Family Members Are Not Valid)
Name: Address: Phone: Nature of Relationship With
Reference
Health
Do you suffer from any chronic illness that may be detrimental to the work environment? Yes ⬜ No ⬜
Do you use any addictive substances? If yes, explain
Yes ⬜ No ⬜
Do you have a clean police record? If no, explain
Yes ⬜ No ⬜
List the Past Four Employment Experiences (Starting with most recent and including present)
Name Of Company: Name Of Supervisor:
Address: Phone:
Reason For Leaving/ Termination:
Time Period of Employment:
What was your job title/ position:
Name Of Company: Name Of Supervisor:
Address: Phone:
Reason For Leaving/ Termination:
Time Period of Employment:
What was your job title/ position:
Name Of Company: Name Of Supervisor:
Address: Phone:
Reason For Leaving/ Termination:
Time Period of Employment:
What was your job title/ position:
Name Of Company: Name Of Supervisor:
Address: Phone:
Reason For Leaving/ Termination:
Time Period of Employment:
What was your job title/ position:
Other
List Languages You Can
Speak:
List Languages You Can
Write:
Through What Medium Did You Hear About This Job Vacancy?
In about 50 words, describe how your knowledge and skills would play a role in the efficient and effective advancement of
the company.
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Please include with this application:
(a) Resume (b) Two letters of recommendation (c) Copy of social security ID (d) Copy of a utility bill to verify address
(e) Official police record (or receipt of application) (f) Copy of driver’s license
Accepted extras include: certificate, awards, diplomas, and report cards
I certify that the information that I have provided on this application is true and complete. I understand that is any
misrepresentation has been made by me verbally or in writing, any offer of employment made to me may be withdrawn or mu
subsequent employment with Benny’s may be terminated.
____________________________ _______________
Applicant's Signature Date
FOR INTERNAL USE ONLY
Interviewed by: Decision after interview:
______________________________________ Discard ⬜ File ⬜ Hire ⬜
Date Interviewed: ______________________ Hourly Rate: _____________
Previous Employer history verified: Salary: __________________
______________________________________ Commission: Yes ⬜ No ⬜
Reference results:
______________________________________
Start Date: ____________________________
Notes:
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