Stellar Services Job Application Form

Instructions: Print clearly in black or blue ink. Answer all questions. Sign, initial and date form.
PART I. PERSONAL INFORMATION:

Date: ____________________

Name: First___________________ Middle ___________ Last _____________________

Address:
Street _________________________ City_______________ State, ___ Zip Code _________
Phone Number:
Home (___) ______________________ Cell (___) _________________________________
Are you eligible to work in the United States?

Yes

No

Have you been convicted of or pleaded no contest to a felony within the last five years?
Yes
No_______
If yes, please explain:
______________________________________________________________________________
______________________________________________________________________________
Voluntary Information
This information is being requested in accordance with federal regulations. The information is
voluntary and will not be used when considering you for employment with our company.
Racial or Ethnic Group
American Indian/Alaskan
Asian/Pacific Islander
Black/African American
Hispanic/Latino
White/Caucasian
Other
Gender
Female
Male
Referral
Newspaper
Company Employee ________________ (name)
Professional Publication
Job Fair
Placement Office
Website___________________________
PART II. POSITION/AVAILABILITY:
Position Applied For ________________________________________
What date are you available to start work? ________________________________________
Expected Salary: _______________________
PART III. EDUCATION:
Name and Address of School - Degree/Diploma - Graduation Date
___________________________________________________________________________
___________________________________________________________________________
Skills and Qualifications: Licenses, Certifications, Skills, Training, Awards
___________________________________________________________________________
___________________________________________________________________________
PART IV. EMPLOYMENT HISTORY:
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Stellar Services Job Application Form (continued)

Present Or Last Position:
Employer: __________________________________________________________________
Address: ______________________________________________________
Supervisor: ____________________________________________________
Phone: __________________________ Email: ________________________
Position Title: _________________________ From: ______________ To: ______________
Responsibilities: ________________________________________________________________
______________________________________________________________________________
Salary: _______________ Reason for Leaving: _______________________________________
Previous Position:
Employer: _____________________________________________________
Address: ______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________ Email: ____________________
Position Title: _________________________ From: ______________ To: ______________
Responsibilities: _______________________________________________________________
_____________________________________________________________________________
Salary: __________ Reason for Leaving: ___________________________________________
Previous Position:
Employer: _____________________________________________________
Address: ______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________ Email: ____________________
Position Title: _________________________ From: ______________ To: ______________
Responsibilities: _______________________________________________________________
_____________________________________________________________________________
Salary: __________ Reason for Leaving: ___________________________________________
Previous Position:
Employer: _____________________________________________________
Address: ______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________ Email: ____________________
Position Title: _________________________ From: ______________ To: ______________
Responsibilities: _______________________________________________________________
_____________________________________________________________________________
Salary: __________ Reason for Leaving: ___________________________________________
May We Contact Your Present Employer?
Yes
No_______
References:
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Stellar Services Job Application Form (continued)

Name/Title, Address, Phone:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
I certify that information contained in this application is true and complete. I understand that
false information may be grounds for not hiring me or for immediate termination of employment
at any point in the future if I am hired. I authorize the verification of any or all information listed
above.

Signature______________________________
Stellar Services, Inc. (Company) is committed to the principles of equal employment opportunity and to compliance with all federal, state and
local laws concerning discrimination in employment. To this end, our Company ensures equal opportunity to all employees, applicants and other
individuals regardless of race, color, disability, religion, creed, ancestry, age, gender, national origin, sex, , veteran status, marital status, sexual
orientation, or citizenship status. The policy of equal opportunity will be observed with respect to all employment practices including, but not
limited to, recruitment, job assignment, transfer, re-employment, compensation, benefits, promotions, terminations, and Company related
programs.

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