Application for Employment

 
Aurora Senior Day - 300 L Street, Aurora, NE 68818 - 402-694-6968
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employmnet on any basis including race, color, age, sex, religion, handicap or national origin.
Personal Information  
Name:
Date:
 Social Security Number:
Address:
  
Phone Number(s):
  
Referred By:
 Are you 18 years of age or older?
Employment Desired    
Position:
 Date You Can Start:
 Salary Desired :
Are You Employed Now?

 If so, may we inquire of your present employer?
Education    
  Name and Location of School Last Yr. Completed: Did You Graduate? Degree Received:
High School



College
Former Employers    
List below your last three employers, starting with the last one first.
Date: Name and Address of Employer Salary Position Reason for Leaving
From:
To:
From:
To:
From:
To:
References    
List below three persons not related to you, whom you have known at least one year.
Name: Phone: Position/Relationship
1.
2.
3.

Please answer this question: "Why do you feel you are qualified for this position?"