FANCHER CHAIR COMPANY

Employment Application


APPLICANT INFORMATION
First Name:
Last Name:
Middle Initial:
Date:
Email:
Street Address:
Apartment/Unit#:
City:
State:
Zip:
Phone:
Cell:
Date Available:
Desired Wage:
Willing to work 2nd or 3rd shift?:
 Yes
No
Kind of work desired?:
Kind of work you can do?:
Are you a United
States citizen?:
 Yes
No
If no, are you authorized
to work in the United States?:
 Yes
No
Have you ever worked for this company?:
 Yes
No
If so, when & what department?:
Do you know anyone currently working for us?:
 Yes
No
If yes, who?:
 

EDUCATION
High School:
City & State:
From:
To:
Did you graduate?:
 Yes
No
Diploma:


College/University:
City & State:
From:
To:
Did you graduate?:
 Yes
No
Degree:


Other School:
City & State:
From:
To:
Did you graduate?:
 Yes
No
Degree:
 

REFERENCES

Please list three professional references.

Full Name:
Relationship:
Company:
Phone:
Address:


Full Name:
Relationship:
Company:
Phone:
Address:


Full Name:
Relationship:
Company:
Phone:
Address:
 

PREVIOUS EMPLOYMENT
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Wage:
Ending Wage:
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous
supervisor for a reference?:
 Yes
No


Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Wage:
Ending Wage:
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous
supervisor for a reference?:
 Yes
No


Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Wage:
Ending Wage:
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous
supervisor for a reference?:
 Yes
No

DISCLAIMER and SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. I hereby grant permission to investigate any of the above information and to submit to medical examination if required.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. This application does not indicate that there are positions available and does not in any way obligate this company.
Signature (type full name):
Date:


IMPORTANT: PLEASE EMAIL RESUME TO: accounting@fancherchair.com
or mail to: Fancher Chair, P.O. Box 8, Falconer, NY 14733

For a printable PDF copy of this form click here.
 

Fancher Chair
P.O. Box 8
Falconer, NY 14733

Phone: 716-665-4313
Fax: 716-661-3018

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