Predesigned Sites

HOW DID YOU HEAR ABOUT THIS POSITION?

DATE*

LAST*

FIRST*

MIDDLE

STREET

CITY

STATE

ZIP

STREET

CITY

STATE

ZIP

PHONE NUMBER*

Are you 18 years or older?*

Yes No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?*

Yes No

POSITION

DATE YOU CAN START

SALARY DESIRED

ARE YOU EMPLOYED NOW?

Yes No

IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?

Yes No

EVER APPLIED TO THIS COMPANY BEFORE?

Yes No

WHERE?

WHEN?

High School Name & Location

Number of Years Attended

Did you Graduate?

Yes No

Subjects Studied

College Name & Location

Number of Years Attended

Did you Graduate?

Yes No

Subjects Studied

College Name & Location

Number of Years Attended

Did you Graduate?

Yes No

Subjects Studied

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK:

SPECIAL SKILLS

ACTIVITIES: (CIVIC, ATHLETIC, ETC.) exclude organizations, the name of which indicates the race, creed, sex, marital status, color or nation of origin of its members.

U.S. MILITARY OF NAVAL SERVICE

RANK

PRESENT MEMBERSHIP IN NATIONAL GUARD OR RESERVES

Former Employers (list last three employers, starting with last one first).

PLEASE LIST EMPLOYER NAME & ADDRESS, DATE STARTED & DATE ENDED, SALARY, POSITION, AND REASON FOR LEAVING

WHICH OF THESE JOBS DID YOU LIKE BEST AND WHY?

PLEASE GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's President, and then only when in writing and signed by the President, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."

DATE

SIGNATURE: Enter your initials below