Join The Piraino Team Application for Employment Personal Information Name (Last Name First) Social Security No. Present Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code Permanent Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code Phone No. Referred By End Section Employment Desired Position Date you can start Salary Desired Are you employed? Yes No If so, may we inquire of your present employer? Yes No Ever applied to this company before? Yes No Where? When? End Section Education Name & Location of School Years Attended Did you graduate? Subjects studied Grammar School High School College Trade, Business or Correspondence School End Section General Information Subject of special study/research work or special training/skills U.S. Military or Naval Service Rank End Section Former Employers List below last four employers, starting with most recent Start & End Date Name & Address of Employer Salary Position Reason for leaving End Section References Give below the names of three persons not related to you whom you have known at least one year Name Address Business Years Known End Section Authorization "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.” Authoization I agree to the above. Date End Section Essay Write a page essay on one of the topics below What influenced you to become a Hairdresser? OR What makes you different from the average beauty school student? End Section reCAPTCHA If you are human, leave this field blank.