Personal Data

In order that we may understand your qualifications and interests, and to assure you the fullest consideration, please complete all of the items listed. (Please print clearly)

List all educational institutions in order of attendance starting with the last high school attended

Education Name and Location of School Did You Graduate? Major/Degree
High School / Yes No / GED Diploma
College / Yes No
Technical/
Vocational School / Yes No

.

Vocational Skills

Name office machines you can operate with or without reasonable accommodations:

Computer Software/Hardware used

If Known, Typing WPM Ten-key strokes/Minute

Please list any other equipment used

Describe any specialized training, apprenticeship, skills and extra-curricular activities:

Describe any job related training received in the United States Military

Employment Record Begin with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. If you need additional space, please continue on a separate sheet of paper.

Employer Name
Address
City/State/Zip Code
Phone Number / Name of last Supervisor / Dates of Employment
FR:
TO: / Hourly Rate
Start:
Final:
Reason for Leaving
Work Performed/Responsibilities
Employer Name
Address
City/State/Zip Code
Phone Number / Name of last Supervisor / Dates of Employment
FR:
TO: / Hourly Rate
Start:
Final:
Reason for Leaving
Work Performed/Responsibilities
Employer Name
Address
City/State/Zip Code
Phone Number / Name of last Supervisor / Dates of Employment
FR:
TO: / Hourly Rate
Start:
Final:
Reason for Leaving
Work Performed/Responsibilities
Employer Name
Address
City/State/Zip Code
Phone Number / Name of last Supervisor / Dates of Employment
FR:
TO: / Hourly Rate
Start:
Final:
Reason for Leaving
Work Performed/Responsibilities

References List three references other than relatives

Name and Occupation / Telephone Number / Relationship

Language Fluency If you read, write, and/or speak any foreign languages, you may explain below.

Honors, Awards, Etc. Please list any honors, prizes, awards, activities, offices held, professional organization, memberships, volunteer work, publications, licensing/certifications, etc. You may exclude those which indicate race, color, religion, sex, marital status, age, national origin, disability, veteran status, or any other legally status.

Additional Information Please include any additional information you feel may be helpful in evaluating this application. Use additional sheets if necessary.

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.I acknowledge and certify that I have read and signed the “Applicant’s Statement and Release Authorization” attached.

Signature of Applicant Date