MARCHAND PAINTING INC.

Employment Application

APPLICANT INFORMATION

Last Name		First		M.I.		Date

Street Address

Apartment/Unit #

City

State

Zip

Email

Phone

Date Available

Social Security No.

Desired Salary

Are you a citizen of the United States

YesNo

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

YesNoYes, I am a citizen

Have you ever been convicted of a felony?

YesNo

If yes, please explain?

REFERENCES
Please list three professional references

1. Full Name		Relationship
Company		Phone

2. Full Name		Relationship
Company		Phone

3. Full Name		Relationship
Company		Phone

PREVIOUS EMPLOYMENT

Company		Phone

Address

Supervisor

Job Title

Rate of Pay

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YesNo

DISCLAIMER AND SUBMIT

By checking the box blow and submitting, you are certifying that:

1. Your answers are true to the best of your knowledge.

2. If this application leads to employment, you understand that false or misleading information in your application or interview may result in release.