Spanish Lookout

Center Road
Tel: +501-823-0132
Fax: +501-823-0463
dieselsys@btl.net

Application for Employment

IMPORTANT: THIS APPLICATION IS TO BE COMPLETED BY THE APPLICANT.
We will consider this application carefully, but it does not guarantee employment.
Personal information

Name:______________________________________________________________________
Home_Address:_______________________________________________________________
Email Address:________________________________________________________________
Telephone Number:___________________________________________________________
Date of Birth:_________________________________________________________________
Social Security Number:________________________________________________________
Authorized to Work in Belize___Yes________No____________________________________
Languages Spoken:____________________________________________________________
Marital Status: _Single:_____Married:______Widowed:_______Common-Law:___________
Do you have a valid Driver's License?_____________________________________________
What position are you applying for:______________________________________________
Have you ever been convicted of a crime? Yes:_____ No:_______
If yes, please give details:______________________________________________________
Education:

School Name Years Completed Diploma/Degree

High School:

College/University:

Other Training, Certification, or Licenses held:

 Work Experience. Please provide details of your two most recent positions held.

Employer:
Address:
Time Employed:
Salary:
Position:
Duties Performed:

Name of your Supervisor:

Reason for leaving:

Employer:
Address:
Time Employed:
Salary:
Position:
Duties Performed:

Name of your Supervisor:

Reason for leaving:
References: Submit three references excluding relatives who we may contact.

Name Title Company Telephone #

Acknowledgement and Authorization:

I certify that all answers given herein are true and complete to the best of my knowledge.
In the event of employment, I understand that false or misleading information given in my application or i
i interview(s) may result in discharge.

__________________________________________________________________________________________________
Signature of Applicant Date