Perry Smith Development
EMPLOYMENT APPLICATION
PERSONAL INFORMATION
Name
*
First
Last
Home Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
----
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Bouvet Island
British Indian Ocean Territory
British Virgin Islands
Brunei
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Burundi
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Cayman Islands
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Chad
Chile
China
Christmas Island
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Colombia
Comoros
Congo - Brazzaville
Congo - Kinshasa
Cook Islands
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Curaçao
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El Salvador
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Gambia
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Ghana
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Greenland
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard & McDonald Islands
Honduras
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Hungary
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Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR China
Republic of North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Caledonia
Nicaragua
Niger
Nigeria
Niue
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North Korea
Northern Mariana Islands
Norway
Oman
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Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé & Príncipe
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Senegal
Serbia
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Sint Maarten
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Slovenia
Solomon Islands
Somalia
South Africa
South Georgia & South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
St. Barthélemy
St. Helena
St. Kitts & Nevis
St. Lucia
St. Martin
St. Pierre & Miquelon
St. Vincent & Grenadines
Sudan
Suriname
Svalbard & Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
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Tuvalu
U.S. Outlying Islands
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis & Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Phone Number:
*
Email Address:
EMPLOYMENT INFORMATION
Position(s) that you are applying for?
*
Cashier
Zipline Guide
Horse Stables
Telephone Reservations
Are you currently employed?
*
Yes
No
Present employer name and location?
How long have you worked for your current employer?
Present salary?
If offered a position, when can you report for work?
*
If hired can you show proof of your legal right to work in the U.S.?
*
Yes
No
Have you ever been dismissed or asked to resign from any position?
*
Yes
No
Have you ever been convicted of a felony or misdemeanor which resulted in
imprisonment? (answering yes will not necessarily disqualify you)
*
Yes
No
If you answered yes to numbers 4 or 5, please explain:
EDUCATION
Where and when did you attend high school? Highest level completed?
*
Where and when did you attend college? Highest level completed?
*
EMPLOYMENT EXPERIENCE
List your most recent employer. Please include your duties, supervisor's name, phone number and dates of employment:
*
List your second most recent employer. Please include your duties, supervisor's name and dates of employment:
*
List your third most recent employer. Please include your duties, supervisor's name and dates of employment:
*
REFERENCES
Provide name and phone number for reference #1
Provide name and phone number for reference #2
Provide name and phone number for reference #3
ACKNOWLEDGEMENT AND SIGNATURE
*
I certify that all information provided by me are true and correct to the best of my knowledge.
*
I authorize Perry Smith Enterprises to investigate any and all information provided by me.
*
I release from liability all persons and organizations reporting information required by this application.
Your full, legal name:
*
Today's date:
*
MM
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