Please fill out the following form
General
Position to which you are applying
Sales Associate
Sales Manager
Administrative
Approximate Wage Expected per week
per year
Date Available to start work
,
1999
2000
Personal
Name
Last
First
Middle
Daytime Phone
Evening Phone
Address
Street
City
State
Zip
Social Security #
Employment Information
Are you presently employed?
Yes
No
If so, may we contact them?
Yes
No
Employer
Phone
Supervisor
Phone
Address
Street
City
State
Zip
Job Title
Describe the Nature of your Duties
Miscellaneous
Do you own or have access to an automobile?
Yes
No
Do you have a valid Drivers License ?
Yes
No
Has your driver's license been revoked or suspended?
Yes
No
If yes, why?
Will you be willing to Transfer if Required?
Yes
No
Have you ever been convicted of a crime ?
Yes
No
if yes, explain
Are you willing to take a physical examination?
Yes
No
Are you able to perform the essential functions of the job for which you are applying?
Yes
No
If no, describe the functions that cannot be performed.
