We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.

     Application for Employment

	Date: 	
I. Personal Information

Name:	 Last	First	 Middle

Present Address

Permanent Address (if different than above)

	____________________	
Social Security Number                                             Telephone	                          Cell phone/pager

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver's license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Position Applied for: 	

1.  Is there any information we would need about your name or use of another name for us to be able to check your work record?  Please specify:

2. Do you have any relatives who are presently (or have formerly been) employed by (Company)?

3. How were you referred to (Company)? 	

4. Have you ever been convicted of a felony? __ Yes   __ No  If yes, please explain:

II. Educational History

	School Name/Location 	Years Completed	Degree/Diploma

Elem/Jr. High 	

High School 	

College 	

Other 	
III. Employment Record  Please include all employment for the last five years.

1.				
	Company Name (Current or Most Recent Employer)	Position Held

			Dates Employed: 	
	Address		From            To

	Manager / Supervisor	Telephone	Wage/Salary

     	__________________________________________
    Reason For Leaving

2.				
	Company Name	Position Held

			Dates Employed: 	
	Address		From            To

	Manager / Supervisor	Telephone	Wage/Salary

	Reason For Leaving

3.				
	Company Name 	Position Held

			Dates Employed: 	
	Address		From            To

	Manager / Supervisor	Telephone	Wage/Salary

	Reason For Leaving

IV. References  Please do not include relatives or former employers.

1.				
	Name		Years Known
				
	Address		Telephone
		
	Occupation
2.				
	Name		Years Known
				
	Address		Telephone
		
	Occupation
3.				
	Name		Years Known
				
	Address		Telephone
		
	Occupation

V. Work Availability
1. If your application receives favorable consideration, when will you be available to begin work?	
2. Do you have any objection to working overtime?	( ) Yes ( ) No
3.Can you work overtime without prior notice?	( ) Yes ( ) No
4.Can you work on Saturday?	( ) Yes ( ) No
5.Can you travel?	( ) Yes ( ) No
6. Do you own your own tools and power saw?                                                                           ( ) Yes ( ) No		

VI. Salary / Hourly Rate Requirements
If your application receives favorable consideration, what salary/hourly rate would you require? 

$			per