Employment Application Form

Please fill out the following form to start the employment application process with Palmer Moving Services.

Application Information

Last Name
Required

First Name
Required

M.I.

Date
Required

Street Address
Required

Apartment/Unit #

City
Required

State
Required

ZIP
Required

Phone
Required
Not a valid phone number

Email Address
Not a valid email

Date Available

Required

Desired Salary

Position Applied for
Required

Are you a citizen of the United States?
YesNo

If no, are you authorized to work in the U.S.?
YesNo

Have you ever worked for this company?
YesNo

If so, when?

Not a valid Date

Have you ever been convicted of a felony?
YesNo

If yes, explain
Please explain

Education

High School

Address

From

Did you graduate?
YesNo

Degree

College

Address

From

Did you graduate?YesNo

Degree

Other

Address

From

Did you graduate?YesNo

Degree

References
Please list three professional references.

Full Name

Relationship

Company

Phone
Not a valid phone number

Address

Full Name

Relationship

Company

Phone
Not a valid phone number

Address

Full Name

Relationship

Company

Phone

Not a valid phone number

Address

Previous Employment

Company

Phone
Not a valid phone number

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Reason for LeavingPlease explain…

May we contact your previous supervisor for a reference?
YesNo

Company

Phone

Not a valid phone number

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Reason for LeavingPlease explain…

May we contact your previous supervisor for a reference?
YesNo

Company

Phone
Not a valid phone number

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

Reason for LeavingPlease explain…

May we contact your previous supervisor for a reference?
YesNo

Military Service

Branch

From

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

Digital Signature (type your full legal name and date of birth)

Required

Date

Required

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 milseading information in my application or interview may result in my release.

RECORDS RELEASE

I hereby request that my police record and/or any criminal court record relating to pending felony charges
and all criminal convictions, as may be obtained from an examination of your files or from any other
knowledge which you may have, be released to the bearer of the agreement stating such policy record of court record, if any.

I hereby waive any and all rights which I may have against you, your department or court, or any of your
officers or employees by reason of your furnishing such record and I also agree to hold harmless in the event of damages suffered from the release of this information both the department or court releasing such information as well as the firm authorizing to receive this information, its divisions, subsidiaries and agents.

This employer is also hereby authorized to conduct an investigation of any previous employment history,
personal history, and/or credit and financial records; employing investigative or credit agencies or bureaus of their choice subject to the provisions of the Fair Credit Reporting Act.
Further, I hereby release all of my previous employers of any and all liability related to the disclosures of any information regarding my employment history provided to the bearer of the document.

Date

Required

Signature

Required

Digital Signature of Applicant (type your full legal name and date of birth)

Required

Street address of applicant

Required

City

Required

State

Required

Zip

Required

ZIP Code must be 5 or 9 digits

Favorite Comedian

Fire or Ice

Height in meters

Careers

Employment Application Form

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