ACME PHOTO & GENERAL STORE EMPLOYMENT APPLICATION FORM

Education	Name & Location of School & Further Educational Institutions	Subjects taken & passed along with Grades/ Certificates/ Diplomas	Academic Year
School
Further Education

General Information

Are you willing to work overtime ?	Yes No	Are you willing to undertake other jobs/tasks?	Yes No
Are you familiar with Georgetown?	Yes No	Approximate travelling time:	Hrs Mins
Do you have or ever had any relatives or friends employed at Acme?		Yes No
If yes, please state name and position
Hobbies:
Source of Application:	Newspapers Television Radio Friends Other
Do you smoke?	Yes No	Do you drink alcohol?	Yes No Sometimes

 

Medical History

Please give details of any accidents, operations or recurring or previous illness (e.g. allergies, asthma, physical injuries) past or present. Please also provide your previous and current Doctor (name & address) or Medical Centre that you seek/sought for medical attention

1)

2)

3)

Declarations

I declare that the answers and information noted on this application are true and correct to the best of my knowledge and belief. I understand that any false information or any unsatisfactory references based on my character and work performance verbal or written, also any misrepresentation or omittion of any information or facts called for in this application is cause for my immediate dismissal. Therefore I hereby authorize an investigation of all statements contained in this application and expressly authorize the release of any medical information concerning my past and present condition by any practitioner or hospital.
Email		Date