ࡱ> ,.  !"#$%&'()*+-E012345679:;<=>?@ABCDGHIJKLMNOPQRRoot EntryF>ŘbƽObjects 秗bƽ@BڗbƽInternal ContentsN  F MSWordArt.29qWordArt cTsBritannic Bold  2d 0  ",N l"@^\ ``tjtj;;>>95))DnFHJLNPRTVXZ\^`bhjl   fv6@C2,,$$pp L0#.,l   L APPLICATION FOR EMPLOYMENT PERSONAL INFORMATION Name Social Security No. Present Address Apt. No. City State Zip Permanent Address Apt. No. City State Zip Are You 18 Years or Older? Phone: Fax: Email: Pager: Yes No DESIRED EMPLOYMENT Position Date You Can Start Salary Desired Are You Employed Now? If So May We Inquire of Your Present Employer? Yes No Yes No Ever Applied To This Company Before? Where? When? Yes No Ever Worked For This Company Before? Where? When? Yes No Reason For Leaving Name of Last Supervisor At This Company Who Referred You To This Company? Employment Agency Newspaper Advertising Friend State Employment Office College Placement Service Walk In Other EDUCATION No. of Years Did You School Level Name and Location of School Attended Graduate? Subjects Studied High School College Trade, Business or Correspondence School GENERAL Subjects of Special Study or Research Work Special Training Special Skills PRE-EMPLOYMENT QUESTIONNAIRE AN EQUAL OPPORTUNITY EMPLOYER FORMER EMPLOYERS List Below Last Three Employers, Starting With The Most Recent One First. Name of Present or Last Employer Address City State Zip Starting Date Leaving Date Job Title Weekly Starting Salary Weekly Final Salary May We Contact Your Supervisor? Yes No Name of Supervisor Title Phone Description of Work Reason for Leaving Name of Previous Employer Address City State Zip Starting Date Leaving Date Job Title Weekly Starting Salary Weekly Final Salary We Contact Your Supervisor? Yes No Name of Supervisor Title Phone Description of Work Reason for Leaving Name of Previous Employer Address City State Zip Starting Date Leaving Date Job Title Weekly Starting Salary Weekly Final Salary May We Contact Supervisor? Yes No Name of Supervisor Title Phone Description of Work Reason for Leaving REFERENCES Below, Give The Names Of Three Persons You Are Not Related To, Whom You Have Known At Least One Year. Name Address Business Years Acquainted 1 2 3 Have you ever served in the Service? ___________. If so, what Branch?____________________________________. Have you ever been convicted of a felony within the last 5 years?____. If yes, explain. (Will not necessarily exclude you from consideration) _________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ Authorization I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified state- ments on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representa- tive of the company has any authority to enter into any agreement for employment for any specificed period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. Date Signature   RTz|12rs r s pq~  " KMOQ   TV  N\^rtvx xz|ELjlnРPgLPg&Pg&Pg&Pg26x!26x!E8 /1BQ\r  R T  # % ' B D e g  ( + @ B V X Z u w  0 W Y n ͽPg&Pg2 2Pg&Pg2Pg&>n p _ a e h l n r uwpS  Pg2Pg& 9999  n   ^$ B%"&'@C'@'@(@(@)@J)@)@)@ )*6* P*\+v++J,,,,!,----K-#.&/ J/ n/ /@< @0@% 0@) 0@' &1@* d1@3 1@43 2@2 22@5 m2@6 2@7 2@8 3@9 Y3@: 3@; 3@=  4@> E4@? 4@@ 4@A 4@B 75@C r5@D 5@E 5@F #6@G ^6@H 6@I 6@J 7@M J7@N 7@O 7@P 7@Q 68@R t8@S 8@T 8@U .9@V l9@e 9@f 9@g &:@h d:@i :@j :@k ;@l \;@m ;@n ;@o <@p N<@q <@r <@s <@t :=@u u=@v =@w =@d &>@^>@]^.?@^?@\^@@Z^>@@P^y@@Q^@@R^@@S^*A@T^eA@V^A@W^A@X^B@Y^QB@O^B@G^B@F^C@E^=C@D^xC@C^C@B^C@A^)D@@^dD@?^D@<^D@;^@E@:^~E@9^E@8^E@7^/F@5^jF@6^F@4^F@2^G@3^VG@1^G@0^G@/^H@.^BH@-^}H@,^H@I^H@[^4I@+^oI@*^I@)^I@(^ J@'^[J@&^J@%^J@$^ K@#^GK@"^K@!^K@ ^K@^3L@^nL@^L@^L@^"M@^`M@^M@^M@^BN@ }N@ "vz  !K#  ^ ),,|W /W"1:MOvzHP Laserjet 5LWINSPOOL\\Ctsserver\hplj5lHP Laserjet 5L@g,,@MSUDOHP LaserJet 4L?\ad "#$%'vz( *^\99999``9999tt;;>>95))#12 4FO]g|Times New RomanSymbolWingdings 3FlexureLucida HandwritingImprint MT ShadowGoudy StoutRockwell Extra BoldGoudy Old StyleHarringtonCopperplate Gothic BoldImpact^  Y\<d]<   \-^.^*&-H[r[no style]heading 1Normalheading 2heading 312124$$     9L0,vz0e0e h ::<%)'*3256789:;=>?@ABCDEFGHIJMNOPQRSTUVefghijklmnopqrstuvwd^\X~( h#X999993d>>X~(%h#(l=>>X~( @h#k>>X~(4ph#>>X~(2njh#Xt])OP7L!x H3 x H3 4" MO;;X~(+h#+;;X~(2h#2;;X~(vQ7h#vQ7;;YR+YRvQ7;;SY+SYvQ7;;j\t%j\tvQ7;;}vQ7}(l=;;ivQ7i(l=;;.VvQ7.V(l=;;چCvQ7چC(l=>>,09Hx/;>>409vQ7;;;X~(fDh#fD;;X~(Ih#I;;X~(Nh#N;;X~(tTh#tT;;X~([h#[;;X~(tXh#tX;;X~(-ah#-a;;X~(Ggh#Gg;;j\t @j\tfD;;tX @tXfD;;BfDBI;;MIMN;;j\tIj\ttT;;MNMtT>>,GHx/NH>>~3G8r6NH>>NHG`KNH>>>OGYRNH>>,F?LHx/M>>~3F?L8r6M>>,zQHx/69S>>~3zQ8r669S>>9d;hf>>69SdUhf>>-adchf>><'h*?i>>lW'h&3Zi>>Gg'hii>>j\t'h$vi;;X~(,}sh#,}s;;X~(wzh#wz;;X~(Αh#Α;;4p;;;u4p;u;;i4pi;;94p9;;X~(h#;;X~(>h#>;;JP+JPvQ7^\ oh#B#99999??]\ZPQRSTVWXYOGFEDCBA@?<;:9875642310/.-,I[+*)('&%$#"! ^\X~( h#j99999<^\X~(ph#ՠ99999>>X~(Hh#j;;X~(lh#l;;X~(B#h#B#;;X~(ܿ&h#ܿ&;;X~(<*h#<*;;X~(̹-h#̹-;;X~(61h#61;;X~(8r6h#8r6;;X~(09h#09;;X~((l=h#(l=;;X~( @h# @;;X~(fDh#fD;;X~(Gh#G;;X~(>Oh#>O;;X~(`Kh#`K;;X~(Th#T;;X~(tXh#tX;;X~([h#[;;X~(n_h#n_;;X~(bh#b;;X~(hfh#hf^\X~(kh#R~99999>>X~(rph#R~;;X~(,}sh#,}s;;X~($vh#$v;;X~(wzh#wz;;+,}s+R~;;GrpGR~;;hfrphfR~;; qrp qR~;;wzlwzB#;;hflhfB#;;ʀJ* ʀJ%;;ʀJlʀJ#;;>x'ZV{])>>']);;ʀJ+ʀJ̹-;;>ޗy^A5|چC>>^AچC>>x\ZV{\^>>\\^^\X~(h#p99999;;-aXdXObject 0F`yɗbƽ җbƽOle CompObjDContentsInternal  OlePres000 /OlePres0018CompObj ^ FMicrosoft Publisher 3.0MSPublisher.39q    i  )&HMSPUB3 H -)&HMSPUB3 H "-f$1KZx -/KAiS{_}y~o iE`KI-p,s*=jsxwZ<9 #i'Z)K)-)((&!xZA<iZK-zfTR;# xZ<:qXL#i_Kd-+%E,U%xxmjgnx`{7(t 4--EKiZX1#<ZgxKyJ5 -9Ki~<zZvxqonmlkln*p-pKvi}r-<Z`x,IU*}$-11Y9<O-[sxZ<)@O{$zp~iMK-~||xxZ<+;N|wzmNib\IWVmW$[ii.@hu<BZmx!-%0%K iE*%<<JTHZ\ac-]Z`KK- "-)&HMSPUB3 H )&HMSPUB3 H)&HMSPUB3 H -)&HMSPUB3 H-2$iK-xZ< i h h K -      x Z <       i K -      x Z < , ,  i K -  xZ<<Zx - K i  < Z x  - K i  < Z x  - K i <Zx-Ki--)&HMSPUB3 H )&HMSPUB3 H)&HMSPUB3 H -)&HMSPUB3 H- $yZ<i"[&TKV@- KG"yrZ<iMK-! 4A 6It+-Khi6BMbv <Zuy-'K;XCiOer| <Z$l6yHt, ry8I HQypZ=<:?biK1 - "8EL^pzyZ<#iOK-  xZ<1 iRK-]L4xqmPZTBt<$85r<oZaxSF8*-Ki  %91R<]UyZ|x|(-Kie%^<BK/Zfy|u)yrZP<y"_[C/+iKI-qnx[ZHRD<3indjKD- r[!xxntqx}-pd&'-K`iyY@;!*<Zvx-Kis"<Zpy-;Ki#v+:SXq 0<R;ZLqyl-- $8HPPCL5MSHP Laserjet 5L\\Ctsserver\hplj5lHP Laserjet 5LI?e???%????@g,,c@MSUDOHP LaserJet 4L \   i  )&HMSPUB3 H -)&HMSPUB3 H "-$KZx -/KAiS{_}|3y~uo iNiN`UKI;>-p,s*>OjsxwZX<9 $%i(Z)K).*-*((&""xs ZA<iZK-{%wgTR</$ xeZ<:rXM(&i_KfAU-,% kH,i\%xxrNmjjgknsv[xS{7iH(qoQ 4,&-5EKUdivrYX=.$ #8<MpZec\xKyJ84&!-9KSim~<yKvZuxqonllkklmn*p-pKvOvi|r-<HZ`x)x*ITh*X|$+"-11Y59; <O-[sxZ<)@O{V3znaH0~sif[MK?1-#~{{{||}~xxcZO=<+ ;LY|FwzsmNi}gb^\IYWVVmVW$X{[^`jdiin:ux{Lx .BKhv-<BVZmx !#$&-&0%E$K#Z in  z_K C*%4<<CJOqTHYZ\_ab`c-a]Z^U%PKK- "-)&HMSPUB3 H )&HMSPUB3 H)&HMSPUB3 H -)&HMSPUB3 H-2$iK-xZ< i h h K -      x Z <       i K -      x Z < , ,  i K -  xZ<<Zx - K i  < Z x  - K i  < Z x  - K i <Zx-Ki--)&HMSPUB3 H )&HMSPUB3 H)&HMSPUB3 H -)&HMSPUB3 H-$UyZ<i"[&ZYWTPpLPKHF0@91-* } v_KF6#yr]ZI<3ieMK5-! $3A_ *8Igu+-HKhi#6BNRabpv %<?XZuy-'4,K;XCiOyZer| &<>UZ"l6yFPjq%+Ig  =r{  8Jh HRrypZV=<!:?_ciYK1 - # '8EL^`pzyZT<#iOK-  x\Z<1  riRK3-l^L5(|xtmP_ZTJBt=7<)855r<oZaxSF8*-Ki-]1Pn %:<1R<^CfUyZ}hx|(->KViotf%^9H<DK/YZfsy|uP)~yrbZP<w;v"_[GA/+vi`KI2-qnx[vZZHRD<31+indjMKKG6*-! v[5)r}Ixxspnntn:qvx}a-pdE%'-CK`ix^W@:" *<OZvx-FKis"<JZpy-;KYi"v+9ASXop 0<BR;ZKa]qy~Al--SummaryInformation(FPOh+'ټ> HGD      y_%45 C y_y_(_y-h̻4