NAHCO Aviance

Head Office: Nahco aviance house,

Employment Application Form

Position of Interest:

INTRODUCTORY INFORMATION:

Name: _________________________________________________________________________
Date: __________________________________________________________________________

Address: _______________________________________________________________________
City: ___________________ State: ____________________ Zip: _________________________
Phone: _________________________________________________________________________

APPLICANT QUESTIONS:
Position Applied: _____________________________ Salary desired: _______________________
Date Available:___________________________________________________________________

If hired, can you be able to start immediately? ________________ Yes ___________No

Have you ever been convicted of, or pled guilt or no contest to, a crime other than a minor traffic
violation ?_______ Yes ___________No

If yes, please explain in detail on a separate piece of paper and include the date of the final disposition
of the case and the nature of the offense. This information will not necessarily disqualify you from
employment but false or misleading information will. Factors such as age and time of the offense,
seriousness, and nature of the violation, and rehabilitation will be taken into account.

EDUCATION:
Highest Qualification:

Name of Institution:_______________________________________________________________
Address of Intitution:______________________________________________________________
Course of Study:_______________________ Number of year’s completed:___________________
Degree/Diploma:_________________________________________________________________
Other Qualification:
Name of Institution:_______________________________________________________________
Address of Intitution:______________________________________________________________
Course of Study:_______________________ Number of year’s completed:___________________
Degree/Diploma:_________________________________________________________________
Secondary School Information:

Name of Institution:_______________________________________________________________
Address of Intitution:______________________________________________________________
From:_______________________ To :___________________
MILITARY EXPERIENCE (if any):

Branch of Service:_________________________________________________________________
From:____________________________________ To:____________________________________

Rank/Type of Service:______________________________________________________________
Special Training/Experience:_________________________________________________________

RECORD OF EMPLOYMENT:

List all your job positions starting with most recent

Employer:________________________________________________________________________
Address:_________________________________________________________________________
Telephone:_______________________________________________________________________

Position Title:_____________________________________________________________________
Supervisor:_______________________________________________________________________
Start Date: ___________________ Date Left:______________ Beginning Salary:_______________

Ending Salary:____________________________________________________________________
Duties:__________________________________________________________________________
Reason for Leaving:________________________________________________________________

Employer:________________________________________________________________________
Telephone:_______________________________________________________________________

Address:_________________________________________________________________________
Position Title:_____________________________________________________________________
Supervisor:_______________________________________________________________________

Start Date: ___________________ Date Left:______________ Beginning Salary:_______________

Employer:________________________________________________________________________

Telephone:_______________________________________________________________________
Address:_________________________________________________________________________
Position Title:_____________________________________________________________________

Supervisor:_______________________________________________________________________
Start Date: ___________________ Date Left:______________ Beginning Salary:_______________
Ending Salary:____________________________________________________________________

Duties:_________________________________________________________________________
Reason for Leaving:_______________________________________________________________

WORK-RELATED REFERENCES: (Do not include relatives)

Name Occupation Tel

1. ________________________ _____________________ ___________________

2. ________________________ _____________________ ___________________

3. ________________________ _____________________ ___________________

STATEMENT (Please read this statement carefully before signing this application):

I understand that employment with NAHCO Aviance is at-will, meaning that the organization or I may
terminate my employment at any time, or for any reason consistent with applicable state or federal
law.

I authorize the Company to conduct a thorough background investigation of any work and personal
history, and verify all data give on this application and during interviews. I hereby release the Company,
and its representatives or agents, from any liability that might result from such an investigation. I
authorize all individuals, schools, and firms named to provide any requested information and release
them from all liability for providing the request information.

I certify that all the statements in this completed application are true and understand that any
falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.

Signature of Applicant:_____________________________

Date Signed:_____________________________________