PERSONAL INFORMATION: Name: Present Address: Phone Number: Mobile/Beeper/Other Number: Are you over the age of 18? Yes No Are you legally eligible for employment in this country? Yes No Are you employed now? Yes No If so, may we inquire of your present employer? Yes No Have you ever applied for a job with us before: Yes No Have you ever been convicted of a felony? Yes No If yes, please explain: (A felony will not necessarily disqualify you from the job) EMPLOYMENT INFORMATION: Referred by: Employment Desired: Full-Time Part-Time Temp. F/T or P/T Salary Requirement: Position applying for: Date available for work: Will you work overtime if asked? Yes No Hours available for work: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Do you have a driver's license? Yes No Have you had any accidents during the past three years? Yes No Have you had any moving violations during the past three years? Yes No What is your means of transportation to work? Driver's license number: State of Issue: Expiration Date: Are there any other experiences, skills or qualifications, which you feel would especially fit you for work with this Organization: EDUCATION INFORMATION: SCHOOLING YEARS COMPLETED DEGREE REC. & MAJOR SUBJECT NAME OF SCHOOL LOCATION DID YOU GRADUATE? (CHECK BOX) GRAMMAR OR HIGH SCHOOL Yes No TRADE BUSINESS OR CORRESPONDENCE Yes No COLLEGE Yes No GRADUATE SCHOOL Yes No Name address & phone of most recent employer: Telephone #: Immediate Supervisor (Name & Position): Date Hired: Date Left: Starting Rate: Last Rate: Your Job Title & Duties: Reason For Leaving: PLEASE EXPLAIN, IN YOUR OWN WORDS, why you want to work for this Company, in what position, and what qualifications you feel you have, or other reasons you feel you should be considered for a position with this company:   The facts set forth in my application for employment are true and complete.  I understand that if employed, false statement on this application shall be considered sufficient cause for dismissal.  You are hereby authorized to make any investigation if my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice. In making this application for employment I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted.  This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.  I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigative report. I understand that employment at this organization is “at will”, and includes no guarantee contract or promise of employment for any specified length of time. I authorize the use of any information in this application to verify my statements, and I authorize the past employers, doctors, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employ. Date:  * required     All new employees are subject to a thorough background investigation, a check into your driving history and a drug screening. We are proud to be a drug free work place. Any discrepancies in conducting these tests may eliminate candidates from employment opportunities.