PERSONAL INFORMATION

DATE: ______________

NAME: _________________________________________________ HOME PHONE :__________________

ADDRESS: ______________________________________________ MOBILE: ________________________
CITY: ____________________STATE______ ZIP: ____________ EMAIL: _________________________
DO YOU HAVE YOUR PORTFOLIO ON THE INTERNET? _____________________________________________________

BIRTH DATE: _____________________ DRIVERS LIC. #: ___________________ SOC. SEC. #: ________________________

SPOUSE: __________________________ PHONE: ________________________
EMERGENCY CONTACT: ___________________________________________ RELATIONSHIP: _______________________
ANYTHING ELSE WE SHOULD BE AWARE OF? (ILLNESS, ALLERGIES, ETC.)

DAYS/HOURS/SHIFT YOU WANT TO WORK:

OTHER HOBBIES/WORK SKILLS:

PREVIOUS EMPLOYMENT
COMPANY NAME: ________________________________________________ TELEPHONE: ______________________
ADDRESS: ___________________________________________________SUPERVISORS NAME: ________________________
JOB TITLE: _______________________ DESCRIPTION: _________________________________________________________
HOW LONG? ______________ REASON FOR LEAVING? _______________________________________________________

COMPANY NAME: ________________________________________________ TELEPHONE: ______________________

ADDRESS: ___________________________________________________SUPERVISORS NAME: ________________________
JOB TITLE: _______________________ DESCRIPTION: _________________________________________________________
HOW LONG? ______________ REASON FOR LEAVING? _______________________________________________________

REFERENCES
NAME: ________________________ TELEPHONE: __________________ RELATIONSHIP: ___________________________
NAME: ________________________ TELEPHONE: __________________ RELATIONSHIP: ___________________________
NAME: ________________________ TELEPHONE: __________________ RELATIONSHIP: ___________________________

JOB DESCRIPTION

JOB POSITION: ____________________ DEPARTMENT: _________________ PAY RATE: __________________________

PROBATIONARY TERMS: __________________________________________________________________________________
___________________________________________________________________________________________________________
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DUTIES/RESPONSIBILITIES:(List in order of importance)_________________________________________________________
___________________________________________________________________________________________________________
__________________________________________________________________________________
DID YOU READ AND SIGN ATTACHED CONTRACT AGREEMENT?_________________
DID YOU READ AND UNDERSTAND STUDIO GUIDELINES? _________________
DID YOU READ TX DEPT HEALTH GUIDELINES? _________________

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EMPLOYEE SIGNATURE MANAGEMENT SIGNATURE