APPLICATION FOR EMPLOYMENT

We are an equal opportunity employer, dedicated to a policy of nondiscrimination in employment

on any basis including race, color, age, sex, religion, disability, or national origin.

APPLICANT INFORMATION

Last Name First M.I. Date

Street Address Apartment/Unit #

City State ZIP

Phone (s) E-mail Address

Last four digits
Date Available XXX – XX– Desired Salary $
of SSN
Position Applied for

Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO

Have you ever worked for this company? YES NO If so, when?

Are you employed now? YES NO If so, may we contact your employer? YES NO

Type of Employment Full-time Part-time Summer Temporary

EDUCATION AND OFFICE SKILLS

High School Address

From To Did you graduate? YES NO

College or
Trade Address
School
From To Did you graduate? YES NO Degree

Years of Typing Words Per Other Office

Printer Copier Fax Scanner Calculator
Experience Minute Equipment Used
Computer Software and
Hardware Experience

EMPLOYMENT HISTORY (LIST PRESENT OR MOST RECENT POSITIONS FIRST)

Company Phone
Name and
Address Position of
Supervisor
Ending
Job Title Starting Salary $ $
Salary

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

WFSCT (09-20-2010)
 EMPLOYMENT HISTORY (CONTINUED)

Company Phone
Name and
Address Position of
Supervisor
Ending
Job Title Starting Salary $ $
Salary

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone
Name and
Address Position of
Supervisor
Ending
Job Title Starting Salary $ $
Salary

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone
Name and
Address Position of
Supervisor
Ending
Job Title Starting Salary $ $
Salary

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

MILITARY SERVICE

Branch From To

Rank at Discharge Type of Discharge

If other than honorable, explain

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.

Signature Date

WFSCT (09-20-2010)