SDL Application

1145 Camden Ave. - Rock Hill, SC 29732 - 803-324-4040

Date of Application:

Name:

Address:

City:

State:

Zip:

Phone:

E-Mail:

SS#:

Salary Desired:

hr. yr.

Have you been convicted of a felony in the last seven years?

Yes No

(Such conviction may be relevant or job-related, but does not bar you from employment)

If yes, please explain:

Referred to us by:

Driver’s License #
(if required by job):

What are you hobbies?

Employment History

List your last 3 employers, assignments, or volunteer activities, starting with the most recent, including military experience.

Employer 1:

Address:

City:

State:

Zip:

Phone:

Employed From:

Job Title:

Immediate Supervisor:

Title:

Summarize the nature of work performed and job responsibilities:

Reason for Leaving:

Hourly Rate/Salary:

Starting Pay:

hr. yr.

Ending Pay:

hr. yr.

Employer 2:

Address:

City:

State:

Zip:

Phone:

Employed From:

Job Title:

Immediate Supervisor:

Title:

Summarize the nature of work performed and job responsibilities:

Reason for Leaving:

Hourly Rate/Salary:

Starting Pay:

hr. yr.

Ending Pay:

hr. yr.

Employer 3:

Address:

City:

State:

Zip:

Phone:

Employed From:

Job Title:

Immediate Supervisor:

Title:

Summarize the nature of work performed and job responsibilities:

Reason for Leaving:

Hourly Rate/Salary:

Starting Pay:

hr. yr.

Ending Pay:

hr. yr.

Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our company

Educational Background

High School Name:

Location:

Years Completed:

Graduated Did not Graduate

Course of Study:

College Name:

Location:

Years Completed:

Major:

Degree:

Other Education:

Location:

Years Completed:

Graduated Did not Graduate

Course of Study:

References

Reference 1:

Phone:

Years Known:

Reference 2:

Phone:

Years Known:

Reference 3:

Phone:

Years Known:

It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the Sherer Dental Lab’s service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, Sherer Dental Lab reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of Sherer Dental Lab has the authority to make any assurances to the contrary.

By submitting this application, I give Sherer Dental Lab the right to investigate all references and to secure additional information about me if job related. I hereby release from liability Sherer Dental Lab and its representatives for seeking such information and all other persons, corporations, and organizations for furnishing such information.

I understand that any offer of employment is subject to a contingent upon successfully passing to Sherer Dental Lab’s satisfaction, its pre-employment drug test, security investigation, and any other qualifying test it may require.

I understand that nothing contained in the application, or conveyed during any interview that may be granted or during my employment, if hired, is intended to create an employment contract between the company and me unless made in writing and signed by me and the Company’s designated representative.

Electronic Signature:
(type full name if you agree to the above conditions)