Employment Application

All fields are required

Name

Phone

Address

City

State

Zip

Are you at least 18 years old?

Are you legally authorized to work in the U.S.

Have you ever worked for Burton Industries?

Position applied for

Salary preference

Have you ever been convicted of a crime or pleaded no contest for any offense or violation other than minor traffic violations?

Institution 1

Institution name

Institution Address

Program name

Degree earned

Years attended

Institution 2

Institution name

Institution address

Program name

Degree earned

Years attended

Institution 3

Institution name

Institution Address

Program name

Degree earned

Years attended

Employment History 1

Company Name

Location

Phone

Job title

Salary

Dates employed

Reason for leaving

Employment History 2

Company Name

Location

Phone

Job title

Salary

Dates employed

Reason for leaving

Employment History 3

Company Name

Location

Phone

Job title

Salary

Dates employed

Reason for leaving

Reference 1

Name

Address

Phone

Relationship

Reference 2

Name

Address

Phone

Relationship

Reference 3

Name

Address

Phone

Relationship

Comments

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The information provided on this form will be considered an Employment Application and will be treated as such. All information provided is considered confidential and will be used solely for the purpose of the recruiting process.

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Employment Application

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