APPLICATION FOR EMPLOYMENT

We are an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis including race, color, age, sex, religion, disability, or national origin. APPLICANT INFORMATION
Last Name State E-mail Address Last four digits of SSN XXX XX Desired Salary $ First Dat e Apartment/Unit # M.I. ZIP

Street Address City Phone (s)

Date Available

Position Applied for Are you a citizen of the United States? Have you ever worked for this company? Are you employed now? Type of Employment

YES YES YES Full-time

NO NO NO

If no, are you authorized to work in the U.S.? If so, when? If so, may we contact your employer? Part-time Summer

YES

NO

YES

NO

Temporary

EDUCATION AND OFFICE SKILLS

High School From College or Trade School From To Did you graduate? Words Per Minute To Did you graduate? Address YES Address YES Other Office Equipment Used NO NO Degree Printer Copier Fax Scanner Calculator

Years of Typing Experience

Computer Software and Hardware Experience

EMPLOYMENT HISTORY POSITIONS FIRST)

Compan y Address Job Title To Reason for Leaving YES Starting Salary

(LIST PRESENT OR MOST RECENT

Phone Ending Salary $

Name and Position of Supervisor $

Responsibilities From

May we contact your previous supervisor for a reference?

NO

WFSCT (09-20-2010)

EMPLOYMENT HISTORY
Compan y Address Job Title To

(CONTINUED)
Phone Ending Salary $

Name and Position of Supervisor Starting Salary $

Responsibilities From

Reason for Leaving

YES NO Phone Ending Salary $

May we contact your previous supervisor for a reference? Compan y Address Job Title To Reason for Leaving

Name and Position of Supervisor Starting Salary $

Responsibilities From

YES NO Phone Ending Salary $

May we contact your previous supervisor for a reference? Compan y Address Job Title To Reason for Leaving

Name and Position of Supervisor Starting Salary $

Responsibilities From

YES NO

May we contact your previous supervisor for a reference?

MILITARY SERVICE
Branch From To

Rank at Discharge

Type of Discharge

If other than honorable, explain

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Signatur e

Date

WFSCT (09-20-2010)