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Application for Employment

Personal Information

Your Name:
Your Address:
Phone #: Email:

Employment Desired

Position: Date You Can Start:
Are You Employed? Yes No If so, may we inquire of your present employer? Yes No
Have you ever applied to this company before? Yes No

Education History

Years Attended
High School
Trade, Business,
or Correspondence School

Other Information

Military Service Rank

Former Employers

(List last four employers, starting with the last one first)
Date Started
Date Ended
Name and Location
of Employer
Reason for Leaving


List three persons not related to you, whom you have know at least one year.
Years Known


"I certify that all information I have entered on this application are true and complete to the best of my knowledge and I understand that if I have been employed and the information on my application is found to be falsified, I will be subject to dismissal.

I authorize investigation of all statements I have made on this application and give Burlington Junction Railway authorization to contact current or previous employers and references I have listed on this application. I release Burlington Junction Railway from any and all liability for any damage that may result from utilization of information obtained from employers and references listed on this application.

I understand and agree that only the General Manager or a current employee with direct permission of the General Manager has authorization to enter into any agreement for employment."

Please enter your initials as your signature of consent with the above statement: (required)