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Northern Technologies International Corporation Employment Application

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Northern Technologies International Corporation Employment Application

APPLICANT INFORMATION

Last Name: *

First Name: *

M.I.: *

Date: *

Street Address: *

Apartment/Unit #:

City: *

State: *

Zip: *

Phone: *

County of Residence:

E-mail Address: *

Date Available: *

Desired Salary: *

Position Applied for: *

Are you 18 years of age or over?: *

YES

If no, Date of Birth?:

Are you a citizen of the United States?: *

YES

If no, are you authorized to work in the U.S.?:

YES

EDUCATION - HIGH SCHOOL

High School: *

Address: *

From: *

To: *

Did you graduate?: *

YES

Degree: *

EDUCATION - COLLEGE

College Name: *

Address: *

From: *

To: *

Did you graduate?: *

YES

Degree Major/Minor: *

EDUCATION - COLLEGE

College Name:

Address:

From:

To:

Did you graduate?:

YES

Degree Major/Minor:

REFERENCES

Please provide names of individuals outside of relatives who can be contacted regarding your qualifications, work habits, and character.

Full Name: *

Relationship: *

Address: *

Phone: *

REFERENCES

Please provide names of individuals outside of relatives who can be contacted regarding your qualifications, work habits, and character.

Full Name: *

Relationship: *

Address: *

Phone: *

REFERENCES

Please provide names of individuals outside of relatives who can be contacted regarding your qualifications, work habits, and character.

Full Name: *

Relationship: *

Address: *

Phone: *

PREVIOUS EMPLOYMENT 1

Company: *

Phone: *

Address: *

Supervisor: *

Job Title: *

Starting Salary: *

Ending Salary: *

Responsibilities: *

From: *

To: *

Reason for Leaving: *

PREVIOUS EMPLOYMENT 2

Company: *

Phone: *

Address: *

Supervisor: *

Job Title: *

Starting Salary: *

Ending Salary: *

Responsibilities: *

From: *

To: *

Reason for Leaving: *

PREVIOUS EMPLOYMENT 3

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for Leaving:

CRIMINAL HISTORY

Have you ever been convicted of a felony?: *

YES

If yes, explain:

PHYSICAL RECORD

Do you have any physical limitations that preclude you from performing any work for which you are being considered?: *

YES

If yes, explain:

In Case of Emergency Notify:

Address:

Telephone number:

DISCLAIMER AND SIGNATURE

I certified that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my immediate release. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning any pertinent information they may have personal or otherwise. I release all parties from all liability for any damage that may incur. I understand and agree that if a conditional offer of employment has been made I will be tested for controlled substances and a criminal and/or credit background check will be obtained. I understand and agree that my employment is at-will, is for no definite period may, regardless of the time and manner of payment of my wages or salary, be terminated at any time, with or without cause, and without any previous notice. I serve "At Will".

Print your name: *

Date: *