Employment Application

Personal Information
*Fields are required.

*First Name:

*Last Name:

*Present Address:

Permanent Address
(if different than above):

*City:

*State:

*Zip Code:

*Phone:

Are you 18 years old or older?:

Yes
No

Are you prevented from lawfully becoming employed in this country because of VISA or Immigration status?

yes
no

Employment Desired

Position:

Sales
Service
Administration
Parts

Date you can start

Salary Desired

Are you employed now?

Yes
No

If yes, may we inquire of your present employer?

Yes
No

Ever applied to this company before?

Yes
No

If yes, Where?

If yes, When?

Referred By:

Education

Grammar School
Name and location of school:
Number of years attended:
Did You Graduate?	Yes No
Subjects Studied:

High School
Name and Location of school:
Number of years attended:
Did You Graduate?	Yes No
Subjects Studied:

College
Name and Location of school:
Number of years attended:
Did You Graduate?	Yes No
Subjects Studied:

Trade, Business, or Correspondence School
Name and Location of school:
Number of years attended:
Did You Graduate?	Yes No
Subjects Studied:

General

Subjects of special study
or research work:

Special Skills:

**Activities: (Civic, Athletic, etc.)

**Exclude Organizations, the name of which indicates the race, creed, sex, age, martial status, color, or nation of origin of its members.

U.S. Military Service:

Rank:

Present Membership in National Guard or Reserves:

Former Employers
(list below the last three employers, starting with the last one first).

Employer 1
Employer Name :
Employer Address:
Position:
Employed From:	Month Year
Employed To:	Month Year
Salary:
Reason for leaving:

Employer 2
Employer Name :
Employer Address:
Position:
Employed From:	Month Year
Employed To:	Month Year
Salary:
Reason for leaving:

Employer 3
Employer Name :
Employer Address:
Position:
Employed From:	Month Year
Employed To:	Month Year
Salary:
Reason for leaving:

Which of these jobs did you like best?

What did you like most about this job?

References:
Give the names of three persons not related to you, whom you have know at least one year.

Reference 1
Name :
Address:
Business:
Years Acquainted:

Reference 2
Name :
Address:
Business:
Years Acquainted:

Reference 3
Name :
Address:
Business:
Years Acquainted: