EMPLOYEE APPLICATION
                                                                                     
                                                                                          
DATE OF INTERVIEW:             /             /             
                                                                                                                        INTERVIEWED BY:_______________________
                                                                                                                                   TITLE:_________________________

APPLICANT DATA:

HOW WERE YOU REFERRED TO US:       FRIEND           DRIVE BY               WEBSITE             OTHER:                         

FIRST NAME:                                     
      LAST NAME:                                       PHONE #:                                                       

BIRTHDAY:                                                  
                                E-MAIL ADDRESS:                                                                      

ADDRESS:                                               
  CITY:                                            ST:                        ZIP:                       

SSN#:           -             -            
  LICENSE #:                                         DATE AVAILABLE TO START:               /               /            

ARE YOU UNDER 18 YEARS OF AGE:
          YES            NO

HAVE YOU EVER WORKED FOR THIS COMPANY?    YES      NO       IF YES, WHEN?________________________

ARE YOU A CITIZEN OF THE U.S?
     YES          NO

TYPE OF EMPLOYMENT DESIRED:           FULL TIME         PART TIME         SUBSTITUTE         TEMPORARY

DESIRED STARTING SALARY: ________________

HAVE YOU EVER PLEADED GUILTY, NO CONTEST OR BEEN CONVICTED OF A CRIME?
   YES      NO
IF YES GIVE DATES AND DETAILS: _________________________________________________ ________________________________________________________________________________
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SUMMARIZE CERTIFICATES, TRAINING AND PAST EXPERIENCE: _______________________ __________________________________________________________________________________
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PREVIOUS EMPLOYMENT:

DATES OF EMPLOYMENT:           FROM:                 /                 /                          TO:                /                 /                  

POSITION HELD:                                                                           

RESPONSIBILITIES:                                                                                                                                                                 

                                                                                                                                                                                        

                                                                                                                                                                                           

COMPANY NAME:                                                                            
              PHONE #:                                                         

ADDRESS:                                                    
     CITY:                                      ST:                                ZIP:                            

MANAGER:                                                  
   STARTING SALARY:                                      ENDING SALARY:                    

REASON FOR LEAVING:                                                                                                                                                           

MAY WE CONTACT THIS EMPLOYER FOR A REFERENCE?:
       YES        NO



DATES OF EMPLOYMENT:           FROM:                 /                 /                          TO:                /                 /                  

POSITION HELD:                                                                           

RESPONSIBILITIES:                                                                                                                                                                

                                                                                                                                                                                          

                                                                                                                                                                                             

COMPANY NAME:                                                                               
                PHONE #:                                                     

ADDRESS:                                                      
    CITY:                                      ST:                                ZIP:                            

MANAGER:                                               
      STARTING SALARY:                                     ENDING SALARY:                    

REASON FOR LEAVING:                                                                                                                                                           

MAY WE CONTACT THIS EMPLOYER FOR A REFERENCE?:
       YES        NO


SCHOOL INFORMATION:

LAST SCHOOL ATTENDED:______________________________   CITY:_____________  ST:________

LAST LEVEL (GRADE) OF EDUCATION:_________________  GRADUATED FROM HIGH SCHOOL:   YES        NO

CURRENT STATUS:        COLLEGE STUDENT         HIGH SCHOOL STUDENT           GRADUATED       N/A

ANY CURRENT OR UPCOMING TRAINING OR EDUCATION COURSES:_________________________

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I CERTIFY THAT MY ANSWERS ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE
YOU TO MAKE SUCH INVESTIGATIONS AND INQUIRIES OF MY PERSONAL, EMPLOYMENT, EDUCATIONAL,
FINANCIAL AND OTHER RELATED MATTERS AS MAY BE NECESSARY FOR AN EMPLOYMENT DECISION. I
HEREBY RELEASE EMPLOYERS,SCHOOLS OR INDIVIDUALS FROM LIABILITY WHEN RESPONDING TO
INQUIRIES IN CONNECTION WITH MY APPLICATION. IN THE EVENT I AM EMPLOYED, I UNDERSTAND THAT
FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION OR INTERVIEW(S) MAY RESULT IN DISCHARGE.

SIGNATURE OF APPLICANT:_____________________________________   DATE: _____________________
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