PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

PLEASE COMPLETE PAGES 1-5.

DATE ________________________________

Name __________________________________________________________________________________________

                        Last                                                                 First                                                                Middle                                                             Maiden

Present address __________________________________________________________________________________

                                                                        Number                                                           Street                                      City                  State                Zip

How long ___________________

Social Security No. _______ –  _____  –  _________

Telephone (      )                                

If under 18, please list age ____________________

Position applied for  (1)_______________________

and salary desired   (2) ______________________

(Be specific)

Days/hours available to work

No Pref _______  Thur _________

Mon __________   Fri __________

Tue __________   Sat _________

Wed _________   Sun _________

How many hours can you work weekly? _______________________   Can you work nights? _______________________

Employment desired          qFULL-TIME ONLY              qPART-TIME ONLY              qFULL- OR PART-TIME

When available for work?______________

________________________________________________________________________________________________

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION
(Complete mailing address)

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

High School

College

Bus. or Trade School

Professional School

HAVE YOU EVER BEEN CONVICTED OF A CRIME?   q No                      q Yes

If yes, explain number of  conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. _______________________________________________

________________________________________________________________________________________________

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

DO YOU HAVE A DRIVER’S LICENSE?          q Yes    q No

What is your means of transportation to work? ___________________________________________________________

Driver’s license
number ___________________________  State of issue  _______        q Operator     q Commercial (CDL)     qChauffeur

Expiration date ______________________

Have you had any accidents during the past three years?

How many? _________________

Have you had any moving violations during the past three years?

How Many? __________________

OFFICE ONLY

                        q Yes                                                                            q Yes                    Word                      q Yes

Typing            q No                 _____ WPM                       10-key    q No                      Processing           q No           _____ WPM

Personal       q Yes            PC          q                           

Computer      q No              Mac         q                           

Other __________________________________________

Skills __________________________________________

Please list two references other than relatives or previous employers.

Name ______________________________________

Name _________________________________________

Position _____________________________________

Position _______________________________________

Company ___________________________________

Company ______________________________________

Address ____________________________________

Address _______________________________________

                _____________________________________

                _______________________________________

Telephone  (      )                                                                       

Telephone  (      )                                                                              

An application form sometimes makes it difficult for an individual to adequately summarize a complete background.  Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES?                    q Yes    q No

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?                         q Yes    q No

Specialty _________________________________  Date Entered ________________  Discharge Date ______________

Work Experience

Please list your work experience for the past five years beginning with your most recent job held.
If you were self-employed, give firm name.  Attach additional sheets if necessary.

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

From

To

Start

Final

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of employer
Address

Name of last supervisor