X-Class Corporation Career Form

YesNo If necessary for the job, are you over the age of (Please mark one):

Year Completed(YYYY-MM-DD)*
YesNo (List two personal references who are not relatives or former supervisors)

EMPLOYMENT: List last employment first and include summer or temporary jobs. Be sure all of your experience or employers related to this job are listed here. In the summary (following this section) or use an extra sheet of paper if necessary.

Additional skills including supervision skills, other languages, or information regarding the career/occupation you wish to bring to the employer’s attention:

In case of accident or illness please contact:

Information to the Applicant: As part of our procedure for processing your employment, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.

If necessary for employment, you may be required to supply your birth certificate or other proof of authorization to work in the US, have a physical examination and / or drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above:

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This innformation is option and failure to provide it will have no affect on your application for employment.