Zarco66

Name of school and address.

Graduated?
Yes No

Number of college credits

Grade Average

Junior high

High school

Trade school


First name	Last name
Middle Initial
Street	City
State	Zip code
Phone number
Social Security Number	Are you 18 years of age or older? No Yes
Date of Birth (OPTIONAL)	Sex Male Female
Name of person to be notified in case of an emergency	Can you perform the essential functions of the job for which you are applying? No Yes
Is your citizenship or immigration status such that you can lawfully work in the U.S.? No Yes If hired, continued employment may be dependent upon proof of citizenship or presentation of Alien registration.
How were you referred to Zarco 66?
Have you ever applied to Zarco 66 or any subsidiaries of Zarco 66? No Yes If yes, Where? Approximate dates?
Have you ever been employed by Zarco 66 or any subsidiaries of Zarco 66? No Yes If yes, Where? Approximate dates?
Do you have any relatives currently employed by Zarco 66 or any Subsidiaries of Zarco 66? No Yes If yes, Where?

Availability		Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
	From
	To

What interested you in Zarco 66?

What are your hobbies, special interests, and activities?

(Do not include those indicating race, creed, nationality, or religion.)

Have you ever been convicted of a felony?
No Yes
If yes, state where, when, and the nature of the offense. (Note: Information regarding conviction record will not necessarily bar applicant from employment, but will be reviewed in light of duties relation for job sought.)

Use the next page for presenting information on previous employment & personal references
ZARCO 66 IS AN EQUAL OPPORTUNITY EMPLOYER
Completing these blocks is strictly voluntary. this information will be used for eeo and other regulatory agency tracking/reporting purposes only. all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, or veteran status.

FROM Mo/Yr. TO: Mo/Yr.	JOB TITLE:	EMPLOYER AND ADDRESS:
EARNINGS: $ PER	DUTIES:	REASON FOR LEAVING:
SUPERVISOR: PHONE NUMBER:

FROM Mo/Yr. TO: Mo/Yr.	JOB TITLE:	EMPLOYER AND ADDRESS:
EARNINGS: $ PER	DUTIES:	REASON FOR LEAVING:
SUPERVISOR: PHONE NUMBER:

FROM Mo/Yr. TO: Mo/Yr.	JOB TITLE:	EMPLOYER AND ADDRESS:
EARNINGS: $ PER	DUTIES:	REASON FOR LEAVING:
SUPERVISOR: PHONE NUMBER:

FROM Mo/Yr. TO: Mo/Yr.	JOB TITLE:	EMPLOYER AND ADDRESS:
EARNINGS: $ PER	DUTIES:	REASON FOR LEAVING:
SUPERVISOR: PHONE NUMBER:

FROM Mo/Yr. TO: Mo/Yr.	JOB TITLE:	EMPLOYER AND ADDRESS:
EARNINGS: $ PER	DUTIES:	REASON FOR LEAVING:
SUPERVISOR: PHONE NUMBER:

LIST BELOW THREE INDIVIDUALS WHO HAVE KNOWN YOU FOR FIVE YEARS OR MORE
Name	Occupation	Address and phone number



I certify, on the penalty of dismissal, that all answers and statements made by me herein and other information given by me pursuant to becoming employed by this company, are true, complete and correct, and are made in good faith. I further certify that I understand that as part of the procedure in processing this application there may include an investigative report whereby information may be obtained through personal interview with me and or third parties, such as family members, former employers, financial sources, friends, neighbors, or others with whom I am acquainted. This inquiry may include information as to my character, general reputation, personal characteristics, and mode of living, whichever may be applicable. I understand that the employment of any employee can be terminated with or without cause, at any time, at the option of either the company or the employee. No employee, representative, manager, official or supervisor of the company other than the Vice President, Corporate Relations & Services, has any authority to enter into any agreement for employment for a specified period of time or make any agreement relative to employment that is contrary to the foregoing.

Contacts: info@zarco66.com