Tullahoma Area Chamber of Commerce

TULLAHOMA AREA CHAMBER OF COMMERCE

APPLICATION FOR EMPLOYMENT

POB 1205 – TULLAHOMA TN 37388

(931) 455.5497

Position(s) Applied For: ______Date: ______

Name: ______

Address: ______City/State: ______

Zip: ______Phone Number: ______

Social Security Number: ______

Are you available to work: Full Time Part Time Temporary

Have you been convicted of a felony within the last 10 years? Yes No

If yes, please explain: ______

______

______

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Special Employment Notice to Veterans, Vietnam Era Veterans, and

Individuals with Physical or Mental Handicaps.

Government contractors are subject to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.

If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment.

If you wish to be identified, please sign: ______

(applicant signature)

Handicapped Individual Disabled Veteran Vietnam Era Veteran

EDUCATION

College/University: ______

Location of School: ______Number of Yrs Attended: ______

Did You Graduates: ______Major: ______

Comments: ______

______

Trade/Business/Correspondence School: ______

Location of School: ______Number of Yrs Attended: ______

Did You Graduates: ______Major: ______

Comments: ______

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ADDITIONAL STUDIES/RESEARCH WORK

Subjects of Special Study/Research Work: ______

______

______

Special Skills: ______

______

______

Activities: ______

______

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PREVIOUS EMPLOYMENT

List below your last three employers, recent first

Dates Employed:
Month & Year (to/from) / Name & Address of Employer / Salary / Position / Reason for Leaving

Comments: ______

______

REFERENCES

Give name, address, and telephone number of three (3) references who are not related to you and are not previous employers.

1.______

2.______

3.______

Have you ever had any job related training in the United States military? Yes No

If yes, please describe: ______

______

Are you physically or otherwise unable to perform the duties of the job for which you are applying?

Yes No

______

Applicant’s Statement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 6 months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and

regulations of the employer.

Signature of Applicant: ______Date: ______

NOTES: (OFFICE USE ONLY) ______

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