PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

 APPLICATION FOR EMPLOYMENT

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

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. _______________________________________________

________________________________________________________________________________________________

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? __________________

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

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

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.

______________________________________________________________________________________________________________