Please answer the following questions

• Are you 18yrs or older?

  Yes

  No

• Available start date

• Salary desired

• Are you employed now?

  Yes

  No

• If so, may we contact your present employer?

  Yes

  No

• Are you able to work -

  Full Time

  Part Time

  Temporary

• What is your military status?

• Can you travel if job requires?

  Yes

  No

  Possibly

• Do you have a valid driver’s license?

  Yes

  No

• What type of driver's license do you have?

  Class A

  Class B

• Have you had a motor vehicle accident or moving violation in the past 3 years?

  Yes

  No

• If YES, please explain:

• Education - Name & Location of School, # of years attended, Did you Graduate?, Subjects Studied

• Trade Experience and Expertise - What type of experience do you have? Be specific

• Former Employers - List below the last three employers, starting with the last one first

• References - Give the name of three persons not related to you, whom you have known at least one year.

• Physical Record - Do you have any physical limitations that preclude you from performing any work for which you are being considered?

  Yes

  No

• If YES, what can be done to accommodate your limitations?