Employment Application

Employment Committee
PO Box 40
Conchas Dam, New Mexico 88416

PLEASE NOTE: It is important that you complete all parts of the application. If your application is incomplete or does not clearly show the experience and/or training required, your application may not be accepted. If you have no information to enter in a section, please write N/A.

Date:_______________________________

Name (First, MI, Last)
Social Security Number
Mailing Address
City, State, and Zip Code
Telephone
Alternate Phone
Email
Job Type
Job Title
Availability to work
I am seeking a Full‐ or Part‐time
How many hours can you work weekly?
Can you work nights?
Date available to begin
If under 18, please list age

Additional Information:

Have you ever been employed by this organization in the past? Yes/No

I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States. Yes/No

Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony? Yes/No - If Yes, please explain:

Do you have a driverʹs license? Yes/No
Driverʹs license number
Issued in what state?
Have you had any accidents during the past three years?
How many?
Have you had any moving violations during the past three years?
How many?

Education Template

School
Location (mailing address)
Years
Completed
Major
Degree or Diploma
High School
College or Business/Trade School

Military

Have you even been in the Armed Forces? Yes/No
Date entered
Are you now a member of the National Guard? Yes/No
Discharge date
Specialty

Work Experience Template

Please list ALL work experience beginning with your most recent job held.  Use this template for each job.

Company
Name of last supervisor
Hrs/week
Address
Start Date
Starting Salary
City, State, and Zip Code
End Date
Final Salary
Phone number
Your last job title
Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact this employer? Yes/No

References

Please include name, phone number, and circumstances of your acquaintance. Exclude relatives and former employers.


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4.


I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with this company terminated.


Signature

Date


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