EMPLOYMENT APPLICATION (Please Print) Full Name Address City State Zip Phone Soc. Sec. # ______Position Applied For Date of Birth ______Are you a citizen of the United States? Yes No If not, do you have work papers? Yes No Are you a veteran? Yes No Branch of Service Education: High School Graduate? Yes No Degree Bus./Trade Graduate? Yes No Degree Col./Univ. Graduate? Yes No Degree Grad./Prof. Graduate? Yes No Degree Previous Employment: (begin with most recent position) Firm Address Supervisor Nature of Business Dates of Employment Ending Salary Position(s) Held Reason For Leaving Firm Address Supervisor Nature of Business Dates of Employment Ending Salary Position(s) Held Reason For Leaving Firm Address Supervisor Nature of Business Dates of Employment Ending Salary Position(s) Held Reason For Leaving References: Please furnish the name, address and phone number of two people to whom you are not related and by whom you have not been employed. Name Phone Address Name Phone Address How did you hear of this position? (person, newspaper, etc.) Summarize your special skills or qualifications

If hired, shirt size? (S) (M) (L) (XL) (XXL)

I certify that my answers are true and complete to the best of my knowledge and authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or persons from all liability in 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

For Department Use Only Action:

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