Position applied for:
Sales  Office Telemarketing Installation

How did you learn about us?
Advertisement  Employment Agency  Friend
Relative  Web Page  Other

If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes  No

Have you ever filed an application with us before?
Yes  No
If yes, give date  

Have you ever been employed with us before?
Yes  No
If yes, give date 

Are you currently employed?
Yes  No

May we contact your present employer?
Yes  No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.
Yes  No

On what date would you be available for work?

Are you available to work: 
Full Time Part Time  Shift Work Temporary

Are you currently on "lay-off" status and subject to recall?
Yes  No

Can you travel if a job requires it?
Yes  No

Have you been convicted of a felony within the last 7 years?
Conviction will not necessarily disqualify an applicant from employment.
Yes  No
If Yes, please explain:

Elementary School:
Name and Address of School: 
Course of Study:
Years Completed:
Diploma/Degree: 

High School:
Name and Address of School: 
Course of Study:
Years Completed:
Diploma/Degree: 

Undergraduate College:
Name and Address of School: 
Course of Study:
Years Completed:
Diploma/Degree: 

Graduate Professional:
Name and Address of School: 
Course of Study:
Years Completed:
Diploma/Degree: 

Other (specify)
Name and Address of School: 
Course of Study:
Years Completed:
Diploma/Degree: 

Indicate any foreign languages you can speak, read and/or write.

Speak Fluent Good Fair

Read Fluent Good Fair

Write Fluent Good Fair

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States military.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities.  You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

1.
Employer

Address

Telephone Number(s)

Job Title

Supervisor

Reason For Leaving

Dates Employed
From    To 
Hourly Rate/Salary
Starting    Final 
Work Performed

2.
Employer

Address

Telephone Number(s)

Job Title

Supervisor

Reason For Leaving

Dates Employed
From    To 
Hourly Rate/Salary
Starting    Final 
Work Performed

3.
Employer

Address

Telephone Number(s)

Job Title

Supervisor

Reason For Leaving

Dates Employed
From    To 
Hourly Rate/Salary
Starting    Final 
Work Performed

4.
Employer

Address

Telephone Number(s)

Job Title

Supervisor

Reason For Leaving

Dates Employed
From    To 
Hourly Rate/Salary
Starting    Final 
Work Performed

List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status:

Applicant's Statement

:I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.  It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the employer.