Employment application for Fox Distributing of Southwest Florida, Inc.

* = Required
Personal Information
Employment Desired
Are you employed?     
If so, may we inquire of
your present employer?
    
Ever applied to
this company before?
    
Education History
Did you graduate?     

Did you graduate?     

Did you graduate?     

Did you graduate?     
General Information
Former Employers
List below last four employers, starting with last one first
Employer Name
and Address:
Salary:
Reason for leaving:

Employer Name
and Address:
Salary:
Reason for leaving:

Employer Name
and Address:
Salary:
Reason for leaving:

Employer Name
and Address:
Salary:
Reason for leaving:
References
Give below the names of three persons not related to you, whom you have known at least one year.
Business:
Years known:

Business:
Years known:

Business:
Years known:
Authorization
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the reference and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."
Date:
* Signature:
(Type name in box; this represents your signature in agreeing to the above)
Note: All information remains confidential and will not be shared with anyone.