PERSONAL INFORMATION

Name  

Social Security  

Phone 

Email 

Address 

City, State ZIP

Have you ever applied with us before?  

Do you have transportation? 

Can present employer be contacted?  

Desired starting pay?  

For what position are you applying? 

During what times are you available to work? 

Are you willing to work:  Overtime? Weekends?  Holiday?

When could you begin work? 

Are you at least 16? 

Have you ever been convicted of a crime?  Is so please explain

List relative/friend:  Name       Phone 

Address

SKILLS AND EXPERIENCE

Please list any special qualifications, training, education, skills, or experience that you feel warrant consideration by the company?

Please list any equipment operating abilities you have which might be useful on the job for which you are applying

EDUCATION

Highest grade completed     GPA    Year Graduated 

College/university    Major

College/university   Major

WORK EXPERIENCE

Present employer     From    To

Supervisor   Phone Number 

Reason for leaving Salary 

Previous employer     From    To

Supervisor   Phone Number 

Reason for leaving Salary 

Next previous employer     From    To

Supervisor   Phone Number 

Reason for leaving Salary 

By submitting this application for employment, I certify that I have read and understand all parts of it and verify that I have truthfully and completely answered all questions.  I understand that falsification of any of the information given herein or on any other employment form is grounds for immediate termination, regardless of when such falsification may be discovered.  I authorize Cornerstone Sew & Vac, Inc. and it's representatives to investigate my education, employment, criminal record and all other aspects of my background relevant to my proposed employment, including all statements made by me in my application for employment.