Billings Montana Employment - Employment Source

*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip Code:
*Phone
*E-mail:
Sex:	Male Female

Employer Name:
Employer City:
Employed From (Month & Year):
Employed Until (Month & Year):
Supervisor Name:
Supervisor Phone:
Type of Work:
Salary:
Reason for Levaing:

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Employer Name:
Employer City:
Employed From (Month & Year):
Employed Until (Month & Year):
Supervisor Name:
Supervisor Phone:
Type of Work:
Salary:
Reason for Levaing:

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Employer Name:
Employer City:
Employed From (MM/YYYY):
Employed Until (MM/YYYY):
Supervisor Name:
Supervisor Phone:
Type of Work:
Salary:
Reason for Levaing:

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Name of High School:
Year completed (YYYY):
Study:
Degree/Diploma?:	Yes No

Name College/University:
Year completed (YYYY):
Study:
Degree/Diploma?:	Yes No

Business/Trade School:
Year completed (YYYY):
Study:
Degree/Diploma?:	Yes No

Are you legally authorized to work in the United States? (If hired you will be required to provide proof of work authorization)	Yes No
Are you at least 18 years of age?	Yes No
Have you been convicted of a felony in the past ten years? (Convictions ARE NOT automatic bar to employment)	Yes No

Please explain conviction(s):

Are you presently employed?	Yes No
May we contact your present employer?	Yes No

Please explain why we cannot contact your present employer:

If hired, when would you be available? (MM/DD/YYYY)

Reference Name:
Reference Occupation:
Reference Address:
City/State/Zip:
Reference Phone:
Relationship to Reference:
How long have you known this person?

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Reference Name:
Reference Occupation:
Reference Address:
City/State/Zip:
Reference Phone:
Relationship to Reference:
How long have you known this person?

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Reference Name:
Reference Occupation:
Reference Address:
City/State/Zip:
Reference Phone:
Relationship to Reference:
How long have you known this person?

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All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. I authorize Employment Source to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background. For the purpose of verifying any information. I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me and/or my employment.

Regardless of whether or not I become employed by Employment Source, I recognize that this application is not and should not be considered a contract of employment. I understand that Employment Source is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time at my option or the company's unless specifically provided otherwise in written employment contract. I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms or conditions of employment other than an officer or official of Employment Source, and then only by means of a signed written document.

Check this box to certify that you have read and accept the above statement.

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