Palermo's 95th Application for Employment

Please take a few minutes and fill out the form below. All information is sent over a secure connection.
We do not share any of the information gathered here with any third parties.
We are an equal opportunity employer.

Personal Information

First Name:       Last Name:

Email:

 

Present Address:

City:       State:       Zip code:

 

Permanent Address:

City:       State:       Zip code:

Phone Number:

Referred by:

 

Employment Desired

Position:

Date You Can Start:

Salary Desired: $

Are You Currently Employed?

If so, may we inquire about your current employer?

Have you ever applied to this company before?

Where?

When?

 

Education History

 

NAME AND LOCATION
OF SCHOOL

YEARS
ATTENDED

DID YOU
GRADUATE?

SUBJECTS
STUDIED

Grammar School

High School

College

Trade, Business or
Correspondence School

General Information

Subjects of special study/research work or special training/skills:

US Military or Naval service:

Rank:

Former Employers

DATE, MONTH AND YEAR

NAME/ADDRESS OF EMPLOYER

SALARY

POSITION

REASON FOR LEAVING

From:

To:

From:

To:

From:

To:

From:

To:

References

Give the names of three persons, not related to you, whom you have known at least one year.

NAME

ADDRESS AND TELEPHONE

BUSINESS

YEARS KNOWN

years

years

years

Questions or Comments

Please Read Carefully Before Submitting the Application

The facts set forth in this application are true and complete. I understand that if employed, false statements on this application may result in immediate dismissal.

As part of the application review process, inquiries may be made regarding former employment, claimed education, driving records and credit of candidates for employment. Your completion of this application attests to the fact that you are aware that these inquiries will be made and that you authorize former employers and related agencies to discuss your employment and other records with a Palermo's representative.

I understand that this agreement supersedes any prior agreements or representations.

I also agree that I am aware that I may be subjected to a pre-employment drug screening and criminal history background investigation. Continued employment will be contingent upon favorable results.