Employment Form - Recinos Imports Limited

EMPLOYMENT / JOB APPLICATION

PERSONAL INFORMATION

FULL NAME: FIRST

SOCIAL SECURITY NUMBER (SSN): _________ DATE OF BIRTH

ADDRESS: ADDRESS

VILLAGE/TOWN/CITY DISTRICT COUNTRY

E-MAIL: PHONE:

ARE YOU A PARENT, GUARDIAN, OR CUSTODIAN OF ANY MINOR(S)? ☐ YES ☐ NO

If yes, indicate number of minors

MARITAL STATUS: ☐ SINGLE ☐ MARRIED ☐ COMMON LAW SPOUSE

FULL NAME OF SPOUSE/PARTNER:

E-MAIL: PHONE:

EMPLOYMENT ELIGIBILITY

POSITION APPLIED FOR:

AVAILABLE TO WORK ANY SHIFT: ☐ YES ☐ NO

EMPLOYMENT DESIRED: ☐ FULL-TIME ☐ PART-TIME DATE AVAILABLE:

AVAILABLE TO WORK OVERTIME: ☐ YES ☐ NO MORNING OR EVENING? ____________

ARE YOU CURRENTLY STUDYING: ☐ YES ☐ NO ONLINE OR ONSITE? NAME OF INSTITUTION FIELD

HAVE YOU EVER WORKED FOR RECINOS IMPORTS LIMITED? ☐ YES* ☐ NO *IF YES, WRITE THE START AND END DATES:

HAVE YOU BEEN CONVICTED IN BELIZE OR ANY OTHER COUNTRY? ☐ YES* ☐ NO *IF YES, PLEASE EXPLAIN:

PRIMARY SCHOOL: ☐ YES ☐ NO

EDUCATION

YEAR: ____________________ To _______________________

HIGH SCHOOL: ☐ YES ☐ NO

YEAR: ____________________ To _______________________

SIXTH FROM: ☐ YES ☐ NO YEAR: ____________________ To _______________________ SPECIFY____________________________________________

BACHELOR’S DEGREE: ☐ YES ☐ NO

YEAR: ____________________ To _______________________

SPECIFY____________________________________________

MASTER’S DEGREE: ☐ YES ☐ NO

YEAR: ____________________ To _______________________

SPECIFY____________________________________________

PREVIOUS EMPLOYMENT

EMPLOYER 1: COMPANY

E-MAIL: __________________________________ PHONE:

ADDRESS: ADDRESS

VILLAGE/TOWN/CITY DISTRICT COUNTRY

JOB TITLE: FROM: TO: RESPONSIBILITIES:_____________________________________________________ REASON FOR LEAVING:

EMPLOYER 2: COMPANY

E-MAIL: __________________________________ PHONE: ADDRESS: ADDRESS

VILLAGE/TOWN/CITY DISTRICT COUNTRY

JOB TITLE: FROM: TO: RESPONSIBILITIES:_____________________________________________________

REASON FOR LEAVING: _______________________________________________________

HEALTH STATUS

DO YOU SUFFER FROM ANY SPECIFIC ILLNESS? ☐ YES ☐ NO

If yes, explain:

ARE YOU REQUIRED TO TAKE MEDICATIONS? ☐ YES ☐ NO

If yes, explain:

ARE YOU ALLERGIC TO ANY FOOD, LIQUID, ANIMAL, OTHER? ☐ YES ☐ NO

If yes, explain:

BACKGROUND CHECK CONSENT

IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? ☐ YES ☐ NO

ARE YOU ABLE TO SUBMIT A CURRENT POLICE RECORD? ☐ YES ☐ NO IS YOUR SOCIAL SECURITY CARD VALID? ☐ YES ☐ NO

DISCLAIMER

The applicant understands that this is an Equal Opportunity Employer and that we are committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered. Write your name at the bottom of each page

Kindly attach a copy of your social security card, a copy of your recent police record and a copy of your degree if applicable.

Submit all printed and signed documents to: Human Resources Recinos Imports Limited #57 Benque Road San Ignacio Town Cayo District, Belize

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.

SIGNATURE DATE

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