Application For Employment           Date (MM/DD/YYYY)     Personal               First Name     Middle name     Last Name     Street Address     City, State, Zip     Home Phone     Business Phone     Soc. Sec. #   - -   Positions Applied For     Who referred you   Advertisement Private Employment Agency   to our company?   Friend Gov't Employment Agency       Relative Other       Walk-in     Are you of legal age to work?   Yes       No   To the best of your knowledge,   Yes   you are legally eligible to work   No   in the United States?   (Should you be hired, you will be required to provide documents verifying your employment eligibility)   Date you are available to start work:   / /   Salary or wages desired   $ / Hr Week   What type of employment are   Full Time   you applying for?   Part Time       Night       Shift       Temporary   If you are applying for Part Time, Night, Shift or temporary employment, please specify days and hours you are available: NOTE: Every consideration will be given to work availability information provided by an applicant; however, there is no guarantee the Company can offer employment that accomodates applicants' availability to work.   Mon AM PM to AM PM Tues AM PM to AM PM Weds AM PM to AM PM Thurs AM PM to AM PM Fri AM PM to AM PM Sat AM PM to AM PM   Have you ever applied for work   Yes   here before?   No   If YES, enter date here: / /   Were you ever employed by us   Yes   before?   No   If YES, enter date here: / /   If you are applying for Full Time   Yes   employment, can you work overtime   No   if necessary?       Are you employed at the present   No   time?   Yes       If YES, can we contact your present employer?       Yes       No   Do you have any relatives now   No   employed by this Company?   Yes       If YES, please list names(s) and department:               Name   Department       Have you ever been bonded in   Yes   prior employment?   No       If YES, list name(s) of employer(s):   Have you ever been convicted of a   Yes   crime (excluding misdemeanors and   No   traffic offenses)?   If YES, list convictions:       (a conviction does not necessarily disqualify an applicant for the position being applied for).   Education               High School       Name     Location     Number of years completed:     Did you graduate?   Yes       No   What was your course of study?   Academic       Business       Trade of Technical       Other   College       Name     Location     Number of years completed:     Did you graduate?   Yes       No   What was your major?     Degree:     Did you enroll in a post-graduate course   Yes   of education?   No       If "Yes", what was your post-graduate field of study?             Degree:   Trade, Business or Correspondence School   Name     Location     Number of years completed:     Did you graduate?   Yes       No   What was your course of training or     study?       Special Qualifications or Skills   Use this space to describe any special     qualifications or skills you have     acquired.     If computer skills are required for the   PC   job position you have applied for,   Mac   please check the boxes that apply to   Both   your experience:       Software applications:   Word Processing Presentation Accounting E-mail Data Processing Internet Graphics Other   Foreign Languages       Indicate foreign language(s) you are familiar with:       Language:   Fluent Speak Good Read Fair Write   Language:   Fluent Speak Good Read Fair Write   Memberships       List Business, Trade, Professional,     Community or Activities Memberships     and any offices you may have held.     (Exclude any Organizations the name and     character of which would reveal race, religion,       national origin or any other protected status):         Prior Employment       (Start with most recent employer)       Employer     Address     City, State, Zip     Phone Number     From   / /   To   / /   Supervisor's Name     Starting Salary/Wages     Final Salary/Wages     Reason for Leaving     Employer     Address     City, State, Zip     Phone Number     From   / /   To   / /   Supervisor's Name     Starting Salary/Wages     Final Salary/Wages     Reason for Leaving     Employer     Address     City, State, Zip     Phone Number     From   / /   To   / /   Supervisor's Name     Starting Salary/Wages     Final Salary/Wages     Reason for Leaving     Employer     Address     City, State, Zip     Phone Number     From (MM/DD/YYYY)   / /   To (MM/DD/YYYY)   / /   Supervisor's Name     Starting Salary/Wages     Final Salary/Wages     Reason for Leaving     Military Service               Were you a member of the U.S.   Yes   Armed Forces?   No