Tri-State Painting & Sandblasting Corp

Mail to: Tri-State Painting 2012 Locust Street St. Paul, IA 52657 TRI-STATE PAINTING & SANDBLASTING CORP. EMPLOYMENT APPLICATION

ANSWER ALL QUESTIONS: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age or physical handicaps. This company offers equal opportunity and treatment to all employees and qualified applicants.

Information will be held confidential. (Print full) Date

Name Social Security No. First Middle Last Address Birth date

Street Month/Day/Year Telephone City, State, Zip Wage Desired Is this phone no. at your residence? yes or no

E-mail Address How long have you lived there? ______

Height ft. in. | Branch and date of USA | Military Service Weight lbs. | ______Are you willing to work: Days Nights Saturdays

Straight Nights (3rd shift) Alternate Shifts

Do you want fulltime, permanent work Temporary Work

Name of relatives or friends now employed by Tri-State Painting & Sandblasting Corp. Division, if any: ______WORK RECORD______List your last or present job first. Account for every month. ______Name of Employer | City & State | Type of work | Rate | Time Employed | Reason for Leaving | | Performed | of | From || To | | | | Pay |Mo | Yr || Mo | Yr | . | | | | | | | | | | | | | | | | . | | | | | | | | | | | | | | | | . | | | | | | | | | | | | | | | | . | | | | | | | | | | | | | | | | . | | | | | | | | | | | | | | | | . | | | | | | | | | | | | | | | | .

Comments Mail to: Tri-State Painting 2012 Locust Street St. Paul, IA 52657

EDUCATION

______

Are you a U.S. Citizen or a Registered Alien? Yes No Driver's License# State

Has your driver's license ever been suspended or revoked?

When State Why?

Do you presently have a valid driver's license? Yes No (You will be asked to produce your driver's license at any interview.)

Do you have dependable transportation (car or truck)? Yes No

Have you ever been convicted of a crime other than a minor traffic violation? Charge

Have you ever been discharge or suspended from work for violating work rules?

Charge Employer

List moving traffic violations committed during the last 3 years

A pre-employment drug test will be required.

Is this a problem? Yes No