Millennium Recruitment Services - Employment Application Form

Contact Details *

First Name:

Surname:

Phone Number:

Mobile Number:

Email:

Street Address:

City:

State/Province:

Zip/Postal Code:

Country:

Date of Birth *

DOB (DD/MM/YYYY): / /

Job Interest

* Position applied for:

* Indicate Availability To Work:

Available To Start:

Referral Source:

Have you ever been employed by us before?

* Are you legally permitted to work in this country? Yes No

* Are you above the minimum working age? Yes No

* Have you ever been convicted of any charges? Yes No

If you answered Yes, please provide details:

Note : A positive response is not an automatic bar to employment with the company. The offense for which the person was convicted in relation to the position to which they have applied will be considered.

Availability *

For each day of the week indicate whether or not you will be available for work. If you are available for that day please indicate the times that you will be available via the FROM and TO input fields.

Monday: From(Time) To(Time)

Tuesday: From(Time) To(Time)

Wednesday: From(Time) To(Time)

Thursday: From(Time) To(Time)

Friday: From(Time) To(Time)

Saturday: From(Time) To(Time)

Sunday: From(Time) To(Time)

Education

Type:

Name:

Location:

Courses:

Status:

Type:

Name:

Location:

Courses:

Status:

Employment History

List previous employers beginning with the most recent.

Dates:

Company Name:

Business Type:

Business Phone:

Address:

Position:

Supervisor:

May we contact your supervisor? Yes No

Ending Salary:

Reason for Leaving:

Job title and duties:

Dates:

Company Name:

Business Type:

Business Phone:

Address:

Position:

Supervisor:

May we contact your supervisor? Yes No

Ending Salary:

Reason for Leaving:

Job title and duties:

Dates:

Company Name:

Business Type:

Business Phone:

Address:

Position:

Supervisor:

May we contact your supervisor? Yes No

Ending Salary:

Reason for Leaving:

Job title and duties:

Professional References

Please list up to three professional references below.

Name
Title
Company Name
Business Phone
Home Phone

Declaration *

I declare that the facts set forth in my application are true and complete. I understand that if I am employed, false information stated in this application shall be sufficient cause for dismissal.