APPLICATION FOR EMPLOYMENT Applying for Position of: Date: Referral Source:AdvertisementFriendRelativeWalk-in PERSONAL INFORMATION Last Name: First Name: Middle Name: Address: City: State: Zip Code: Phone Number: Social Security Number: Drivers License Number: Have you filed an application here before?YesNo If Yes, Give Date: Do you wish to work:Full TimePart Time Wages expected: Are you employed now?YesNo If Yes, may we contact your present employer?YesNo Are you lawfully prevented from being employed in this country because of Visa or Immigration status?YesNo (Proof of citizenship or immigration status will be required upon employment) Date would you be available for work? Are you on lay-off and subject to recall?:YesNo Do you have any physical condition which may limit your ability to perform the job applied for?YesNo If yes what specific impairment? Have you been convicted of a felony in the last 7 years? YesNo Will you undergo a pre-employment examination? YesNo Are any of your relatives and friends employed here? YesNo Do you have your own glazing tools?YesNo Have you served an apprenticeship?YesNo Trade? How Long? Where? Person to notify in case of emergency? Name: Relationship: Address: City: State: Zip Code: Phone Number: EMPLOYMENT HISTORY Company Name: Phone Number: Address: Employed (month and year): From: To: Name of Supervisor: State Your Job Title & Describe Your Work: Reason For Leaving: Company Name: Phone Number: Address: Employed (month and year): From: To: Name of Supervisor: State Your Job Title & Describe Your Work: Reason For Leaving: Company Name: Phone Number: Address: Employed (month and year): From: To: Name of Supervisor: State Your Job Title & Describe Your Work: Reason For Leaving: Company Name: Phone Number: Address: Employed (month and year): From: To: Name of Supervisor: State Your Job Title & Describe Your Work: Reason For Leaving: WE MAY CONTACT THE EMPLOYERS LISTED ABOVE UNLESS YOU INDICATE THOSE YOU DO NOT WANT US TO CONTACT. DO NOT CONTACT Employers No.(s): Reason: DRIVING RECORD Please list any accidents and/or citations you have had in the last five years. If none, please write "none". EDUCATION School Name & Location Elementary School High School Undergraduate College/University Graduate/Professional Years Completed 45678 9101112 1234 1234 Describe Course of Study/Major Diploma/Degree Describe any specialized training, apprenticeship, skills and extra-curricular activities Describe any honors or awards you have received State any additional information you feel may be helpful to us in considering your application REFERENCES Give name, address, and telephone number of three references who are not related to you and are not previous employers Name Address Phone 1. 2. 3.