Name:
Address:
 
Phone Number:
Email address:
   
Date you can start       Salary Desired     
Are you currently employed? 
Yes    No		 If so, may we contact your present employer?
Yes    No
Ever applied to this company before?
Yes    No		 When? (Month/Year)         
 
Education Name and location of school ` attended
(month/year)		 Date graduated
(month/year)		 Subjects studied
High School
to
College
to
Vo-tech.
to


 

Technical Clinics Attended: Factory Training, Parts Manufacturers, Aftermarket, etc.
Subject or Course Title Date Place
 

Experience: How many years do you have?

  Years   Years
Light Fixtures Hang Pictures
Storm Doors Crown Molding
Install Shelving Window Treatment
Garage Openers Weather Stripping
Adjust Doors Electrical Systems
Carpentry Recaulking Tubs
Drywall Repair Vanities
Repair Tile Painting
Repair Faucets Garbage Disposal
Exhaust Fans Realtor Assistance
 
Physical Record:
Do you have any physical condition that affects your ability to perform any of the duties for any position for which you are being considered?    Yes    No
If yes, please explain.
 

Employment Record: (List below your most recent employers starting with your most recent job.)

Date
(Month/Year)
Name and address of employer
Salary
Position
Reason for leaving
From
to
From
to
From
to
From
to
 
References:
Give below the names of three people not related to you, whom you have known at least one year.
Name Address Business Years Known
 
I authorize you to contact my former employers and references given above and to investigate the information I have provided in this application.  I represent that I have fully and accurately answered each question.  I understand misrepresentation or omission of material facts in this application may result in rejection of this application or discipline, including termination of my employment.  I also acknowledge that if I am employed, such employment will be at the will of my employer for no definite period and I may be dismissed without cause, pursuant to applicable law.