Employment Application

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or in the presence of a non- related medical condition or handicap.

Name_________________________________________________ Date__________________

Address_______________________________________________Phone#_________________

City_______________________State_________________Zip_________________

DOB_____________________Are you a citizen of the United States of America? ( )Yes  (  )No                                                    

Have you ever applied here before  (  )Yes  (  )No  When?___________ Position applied for__________________________

Start when_____________________________ (  )Full time   (  )Part time  (  ) Temporary    (  ) Other

Employment experience; Start with your present job or last job. Include military assignments and other volunteer activities. Exclude organizational names which indicate race, color, religion, sex, or national origin.

=================================================================================================================

Employer 1________________________________________________________________________________________________________

Address____________________________________City__________________________State_____________________________________

Phone#_______________________ Supervisor's Name____________________________________________________________________

Job Title______________________________Reason for leaving_____________________________________________________________

Dates of Employment: From___________________To____________________________Salary or Hourly rate_________________________

_______________________________________________________________________________

Employer 2________________________________________________________________________________________________________

Address_______________________________________City______________________________State_______________________________

Phone#_____________________________Supervisor's Name_______________________________________________________________

Job Title_________________________________Reason for Leaving_________________________________________________________

Dates of Employment: From_____________To__________________Salary or Hourly rate_________________________________________

_________________________________________________________________________________________________________________

Employer3________________________________________________________________________________________________________

Address____________________________________City__________________State________________Zip___________________________

Phone#________________________________Supervisor"s Name___________________________________________________________

Job Title_______________________________Reason for Leaving___________________________________________________________

Dates of Employment:From_____________________To_______________________Salary or Hourly rate_____________________________

========================================================================

                                                                   Employment Application part 2

Education

Schools/Collages Attended                                                                         # years                    Year Grad.                     Degree

________________________________________________       ______________  ______________   _______________

________________________________________________       ______________   ______________ ________________

________________________________________________        ______________  ______________  ________________

=============================================================================================================

Describe any special qualifications for this job.

_______________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

References

1. Name______________________________________________________________

    Address________________________________________City____________________________State_____________________________

    Phone#____________________________ Cell#_________________________________Pager#________________________________

2. Name________________________________________________________________

     Address_________________________________________City____________________________State___________________________

     Phone#____________________________Cell#________________________________Pager#__________________________________

3. Name__________________________________________________________________

    Address__________________________________________ City______________________________State________________________

    Phone#_____________________________Cell#_________________________________Pager#________________________________

Drivers License #_________________________________________State______________________Expiration_______________________

Are you a veteran of the U.S. Military service?  (  )Yes  (  )No

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contact of employment. In the event of employment, I undeerstand that false or misleading information given on my application or interview may result in termination.

Signature______________________________________________Date__________________________________________

===============================================================================================================