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Job Application

Application Download (optional)

Upon completion of the job application, please mail to:

Secret Treasures PCR
1219 Rockingham Dr.
Clinton, MS 39056

Date *

Name: *

First

Last

Address:

City:

State:

Zip Code:

Phone:

Email: *

Date Available:

Desired Salary: $

Position Applied For:

Are you a citizen of the United States?

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.

High School:

High School Address:

From: To:

Did you graduate?

Yes
No
Diploma?

College:

Address of College:

From: To:

Did You Graduate

Yes
No
Degree?

Other:

Address:

From: To:

Did you graduate?

Yes
No
Degree?

Please list three professional references:

Relationship:

Company:

Phone:

Address:

Professional reference:

Relationship:

Company:

Phone:

Address:

Please list professional reference:

Relationship:

Company:

Phone:

Address:

Previous Employment:

Address:

Supervisor:

Phone:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From: To:

Reason for leaving:

May we contact your previous supervisor for a reference?

Yes
No

Previous Employment:

Address:

Supervisor:

Phone:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From: To:

Date started to date ended.

Reason for leaving:

May we contact your previous supervisor for a reference?

Yes
No

Previous Employment:

Address:

Supervisor:

Phone:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From: To:

Date started to date ended.

Reason for leaving:

May we contact your previous supervisor for a reference?

Yes
No

Military Service:

From: To:

Date military service began to date military service ended.

Reason for military discharge:

Type of discharge:

If other than honorable, explain:

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.

Email

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