Merit

C orporation

EMPLOYMENT APPLICATION

Complete the application online from the FBLA-PBL Web site. Use the tab key to move through the document.

GENERAL INFORMATION
Name (Last) (First) (Middle Initial) Home Telephone
              (   )     -     
Address (Mailing Address) (City) (State) (Zip) Cell Phone
                     (   )     -     
E-mail Address
     

POSITION
Position or Type of Employment Desired Will Accept:
      Part-Time Full-Time

Have you ever been employed at the Merit Corporation before? Yes No
Date Available      
Are you able to perform the essential functions of the job you are applying for, with or without
reasonable accommodation? Yes No
Salary Desired
     

EDUCATION AND TRAINING

Year
School or Institution Name and Address of School Major Degree
Graduated
High School                        
College                        
College                        
Other                        
Special Abilities and Skills Professional Certificates or Licenses Held
           

Extracurricular Activities Present Community and Professional Affiliations

           

Languages Read, Written or Spoken Fluently Other Than English

     

REFERENCES
List below names and addresses of persons who are qualified to answer questions concerning your fitness for the position(s) you seek other than
those listed in your credential file.

Name Position Address Telephone

                       

                       

AN EQUAL OPPORTUNITY EMPLOYER

                        

WORK EXPERIENCE—Most recent first, include voluntary work and military experience
Employer       Telephone Number (   )     -      From (Month/Year)
Address            
Job Title       Number Employees Supervised       To (Month/Year)
Specific Duties (Maximum 350 characters)      
      Hours Per Week
     
Last Salary
     
Supervisor
     
Reason For Leaving       May We Contact This Employer? Yes No
Employer       Telephone Number (   )     -      From (Month/Year)
Address            
Job Title       Number Employees Supervised       To (Month/Year)
Specific Duties (Maximum 350 characters)      
      Hours Per Week
     
Last Salary
     
Supervisor
     
Reason For Leaving       May We Contact This Employer? Yes No
Employer       Telephone Number (   )     -      From (Month/Year)
Address            
Job Title       Number Employees Supervised       To (Month/Year)
Specific Duties (Maximum 350 characters)      
      Hours Per Week
     
Last Salary
     
Supervisor
     
Reason For Leaving       May We Contact This Employer? Yes No

I certify the information contained in this application is true, correct, and complete. I understand that, if employed, false statements reported on
this application may be considered sufficient cause for dismissal.

Signature of Applicant_________________________________________________________ Date________________

AN EQUAL OPPORTUNITY EMPLOYER