Social Security Number:  

State:  

Zip:  

State:  

Zip:  

Time to call:   Day      Evening

Date you can start:

If so, may we contact this employer?

When?             Date:

School Name

#Years

Graduate?

Subjects of Study

Subjects of special study or research work:

Activities:

(Civic, Athletic, etc.)

For the "General" section of the application (above), PLEASE NOTE: Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members. Thank You.

Rank:

Present Membership in National Guard or Reserves?     Yes     No

Date (MM/YYYY)

Name of Employer

Salary

Position

Reason for Leaving

Name

Phone Number

Business

Years Acquainted

1.

2.

3.

State:

Zip:

Phone:

"I understand this form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.

I understand it is unlawful in the states of Maryland and Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

I understand this form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment Form has been created for general use throughout the United States. Linx Networks, Inc. assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law."

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In Consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."