American Marketing & Cable Employment Application

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Application For Employment Pre-employment Questionnaire Equal Opportunity Employer

Personal Information

Last Name:*	First Name:*	MI:
Social Security No:	E-Mail:
Present Address:*	City:* State:*	Zip:*
Permanent Address:	City: State:	Zip:
Phone: *
Referred By

Employment Desired

Position:* Date You can start:* Salary Desired:*

Are you employed ?: Yes No

If so, may we inquire of your present employer? Yes No

Ever applied to this company before? Yes No

Where? When?

Education History

	Name and location of School	Years Attended	Did you graduate?	Subjects Studied
Grammar School		From: To:	Yes No
High School		From: To:	Yes No
College		From: To:	Yes No
Trade, Business, or Correspondence School		From: To:	Yes No

Choose the highest grade completed: 10 11 12 More		Spoken Languages: English Spanish Other:
Please List Any Certificates, Degrees, Diplomas, Etc:

General Information

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

U.S. Military or Naval Service

Rank

Employment History

Begin with your present employer and work backward in order, listing last four employers.

Employer 1		Employer 2
Length of Term	From: / To: /	Length of Term	From: / To: /
Phone Number		Phone Number
Address		Address
City:	State:	City:	State:
Position Held:		Position Held:
Salary:		Salary:


Reason for Leaving:		Reason for Leaving:

Employer 3		Employer 4
Length of Term	From: / To: /	Length of Term	From: / To: /
Phone Number		Phone Number
Address		Address
City:	State:	City:	State:
Position Held:		Position Held:
Salary:		Salary:
Reason for Leaving:		Reason for Leaving:

References

Name	Address	Business	Years Known

Reference 1

Reference 2

Reference 3

Reference 4

Authorization

Authorization:

"I certify that the facts contained in this application are thorough and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I am over the age of 18.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

I agree *