APPLICATION FOR EMPLOYMENT

PLEASE FILL OUT THIS APPLICATION AS COMPLETELY AS YOU CAN.

Date/Time: 5/9/2008 4:10:40 PM Central Time

THE ACT OF FILLING OUT AND SUBMITTING THIS ONLINE APPLICATION SIGNIFIES THE FOLLOWING: I (YOU) CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT I F ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN E TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGE, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO INTO ANY AGREEMENT FR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.

PERSONAL INFORMATION:

*	= Required Information (Type n/a in the fields that don't apply to you.)

*NAME: First: Middle: Last:

*PRESENT ADDRESS: Street: City: State: Zip:

*PERMANENT ADDRESS: Street: City: State: Zip:

*PHONE#: *E-MAIL ADDRESS:

*ARE YOU 18 YEARS OR OLDER? Yes No If younger than 18, current age:

*ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS?
Yes No

EMPLOYMENT DESIRED:

POSITION: DATE YOU CAN START: SALARY DESIRED:

ARE YOU EMPLOYED NOW? Yes No IF SO MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? Yes No

EVER APPLIED TO THIS COMPANY BEFORE? Yes No WHEN: WHERE:

Referred By:

EDUCATION:

	NAME AND LOCATION OF SCHOOL	# OF YEARS ATTENDED	DID YOU GRADUATE?	SUBJECT STUDIED
GRAMMAR SCHOOL			Yes No
HIGH SCHOOL			Yes No
COLLEGE			Yes No
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL			Yes No

GENERAL:

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK:

SPECIAL SKILLS :

ACTIVITIES: (CIVIC, ATHLETIC, ETC.)
(EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREE, SEX, AGE, MARITAL STATUS, COLOR, OR NATION OF ORIGIN OF IT'S MEMBERS)

U.S. MILITARY OR NAVAL SERVICE: Yes No RANK:

PRESENT MEMBERSHIP IN NATIONAL GUARD OR RESERVES: Yes No

FORMER EMPLOYERS:

(LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST)

DATE: MONTH, AND YEAR (Example Format: 01/06)	NAME AND ADDRESS OF EMPLOYER	SALARY	POSITION	REASON FOR LEAVING
FROM: TO:		$
FROM: TO:		$
FROM: TO:		$
FROM: TO:		$

WHICH OF THESE JOBS DID YOU LIKE BEST?

WHAT DID YOU LIKE MOST ABOUT THIS JOB?

REFERENCES:

(GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.)

NAME	ADDRESS	BUSINESS	YEARS ACQUAINTED
1.
2.
3.

Emergency Contact:

(IN CASE OF EMERGANCY NOTIFY)

NAME: ADDRESS: Phone: