Fike & Fike, Inc.
1701 Clearwater Ave. Suite D
Bloomington, IL 61704
Employment Application
Date:
Personal Information
Last Name:
First Name:
Address:
County:
City:
State:
Zip Code:
Daytime Phone:
Evening Phone:
Residency Information
Please list location of residences for past 3 years:
City
County
State
Zip Code
Dates
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Position Information
Position Applying for:
Expected Salary:
Employment Availability:
Are you willing to work a shift other than the typical 8-5 shift?
Are you willing to be on call after hours?
Transportation
Do you have a valid driver's license?
Are you willing to re-locate to the Bloomington/Normal area?
If not, how far will you be commuting?
Other Information
Have you ever been convicted of a crime other than minor traffic violations?
If so, explain:
Have you ever been convicted of a felony?
If so, explain:
Will you require any time off, over 3 consecutive days, in the next 3 months?
Will you require any time off, over 1 week, in the next 12 months?
Are you a U.S. citizen?
If not, type of visa:
Education
Year of degree:
Degree:
Major:
GPA:
College:
Special/Relevant Certifications:
Year of degree:
Degree:
Major:
GPA:
College:
Year of degree:
Degree:
Major:
GPA:
College:
Employment
(Please list your last 3 employers)
Employer:
Phone Number:
City:
County:
State:
Employed from:
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Supervisor:
Position:
Starting Salary:
Ending Salary
Job Description:
Reason for leaving:
Employer:
Phone Number:
City:
County:
State:
Employed from:
-
Supervisor:
Position:
Starting Salary:
Ending Salary
-
Job Description:
Reason for leaving:
Employer:
Phone Number:
City:
County:
State:
Employed from:
-
-
Supervisor:
Position:
Starting Salary:
Ending Salary
Job Description:
Reason for leaving:
References
Name
Occupation
Address
Phone
Miscellaneous
Names of friends or relatives employed by Fike & Fike, Inc.:
Authorization for Release of Information
I,
, hereby authorize Fike & Fike, Inc. to obtain information including credit reports, criminal reports, reference checks, and other personal information, for the purpose
of evaluating employment application requirements.
X
Signature of applicant
Date