www.BCAPools.

com Employment Application

Applicant Information
Full Name:
Last First M.I. Apartment/Unit # State ZIP Code

Date:

Address:
Street Address City

Phone:

) Social Security No.:

E-mail Address: Desired Salary: $

Date Available: Position Applied for:

YES

NO

YES

NO

Are you a citizen of the United States?

YES NO

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

YES NO

Have you ever worked for this company? Have you ever been convicted of a felony? Cell Phone:

Education
High School: From: College: From: Other: From: To: To: To: Address:
YES NO

Did you graduate? Address:

YES NO

Degree:

Did you graduate? Address:

YES NO

Degree:

Did you graduate?

Degree:

References Please list three references.

Full Name: Company: Address: Full Name: Company: Address: Relationship: Phone: ( ) Relationship: Phone: ( )

Full Name: Company: Address:

Relationship: Phone: ( )

Previous Employment
Company: Address: Job Title: Responsibilities: From: To: Reason for Leaving:
YES NO

Phone: Supervisor: Starting Salary: $

Ending Salary:

May we contact your previous supervisor for a reference? Company: Address: Job Title: Responsibilities: From: To: Reason for Leaving:
YES NO

Phone: Supervisor: Starting Salary: $

Ending Salary:

May we contact your previous supervisor for a reference? Company: Address: Job Title: Responsibilities: From: To: Reason for Leaving:
YES NO

Phone: Supervisor: Starting Salary: $

Ending Salary:

May we contact your previous supervisor for a reference?

Disclaimer and Signature I certify 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 release.
Signature: Date: