Windy Hill

Application For Employment

Personal Information

Present Address
Permanent Address
Phone No
Are You 18 Years Or Older?
Are You Prevented from lawfully becoming employed in this country because of visa or immigration status?

Employment Desired

Date you can start
Salary Desired
Are you employed now?
if so may we inquire of your present employer?
ever applied to this company before?
Referred By

EDUCATION Name And Location Of School * No Of Years Attended * Did You Graduate? Subjects Studied
Grammar School
High School
Trade, Business or Correspondence School


U.S. Military or naval service
present membership in national guard or reserves

*This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.

Former employers   

Date month and year Name and Telephone number salary position reason for leaving


Name Address/Telephone Business Years Acquainted

the following statement applies in: maryland & massachusetts (Fill in name of state)
it is unlawful in the state of to require or adminster a lie detector test as a condition of employment or continued employment. an employer who violates this law shall be subject to criminal penalties and civil liability.

in case of emergency notify

phone no

"I certify that all the information submitted by me on this application is true and complete, and i understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if i am employed, my employment may be terminated at any time.
in consideration of my employment, i agree to conform to the company's rules and regulations, and i agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. i also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. i understand that no company representative, other than it's president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing." I also authorize you to call former employers and references.

Do not write below this line

interviewed by
date reporting to work


employment manager
dept. head
general manager

This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment Form is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.