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Rockingham Taxi

PO Box 671

Greenland NH 03840

Employment Application

Applicant Information

Full Name:

Date:

Last

First

M.I.

Address:

Street Address

Apartment/Unit #

City

State

ZIP Code

Phone:

Email

Date Available:

Social Security No.:

Desired Salary:

$7.25 hr

Position Applied for:

Are you a citizen of the?

YES

NO

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

YES

NO

Have you ever worked for this company?

YES

NO

If yes, when?

Have you ever been convicted of a felony?

YES

NO

If yes, explain:

Education

High School:

Address:

From:

To:

Did you graduate?

YES

NO

Diploma::

College:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

Previous Employment

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Military Service Disclaimer and Signature

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

Signature:

Date:

Please include a Picture of your face that can be used as a passport photo.

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