Courtesy Value Employment Application
(Please provide as much detail as possible below. Required fields are marked *)

PERSONAL INFORMATION
 
NAME:
  *Last Name *First Name Middle Init. Maiden Name
*CURRENT
ADDRESS:
 
  *City *State *Zip Code
*TIME AT
ADDRESS:		 years    months *PRIMARY
PHONE:		 ()    - 
 
*EVER CONVICTED OF A
FELONY OR MISDOMEANER:		 Yes
No 		If YES, provide FULL description of convictions (number of convictions, dates, offenses, sentences,rehabilitation, etc.)
*DO YOU HAVE A VALID
DRIVERS LICENSE :		 Yes
No 		*STATE OF ISSUE :      
*ACCIDENTS LAST
3 YEARS: 		Yes
No 		HOW MANY?

 *MOVING VIOLATIONS
LAST 3 YEARS: 		Yes
No 		HOW MANY?

  
 
 
POSITION INFORMATION
*POSITION: POSITION:
  *EXPECTED SALARY: $   EXPECTED SALARY: $
*EMPLOYMENT
DESIRED:		 Full Time  Part Time  Full or Part Time *START DATE: Immediately   2 Week Notice  Other:
EDUCATION
  SCHOOL NAME LOCATION YEARS
COMPLETED 		MAJOR/DEGREE
*HIGHSCHOOL:

   
City                         State       Zip
COLLEGE:

   
City                         State       Zip
BUS. or TRADE SCHOOL:

   
City                         State       Zip
PROFESSIONAL SCHOOL:

   
City                         State       Zip
FOR APPLICATION TO OFFICE POSITIONS ONLY
TYPING SKILLS: Yes
No
wpm: 		10 KEY SKILLS: Yes
No 		WORD PROCESSING SKILLS: Yes
No
wpm: 		PC SKILLS: Yes
No
PC
Mac
OTHER SKILLS:
 
MILITARY SERVICE
CURRENT OR PRIOR
MILITARY SERVICE: 		Yes
No 		CURRENT OR PRIOR
NATIONAL GUARD: 		Yes
No 		ENLISTMENT DATE: / / SEPARATION DATE: / /
BRANCH: SPECIALTY (MOS):
 
EMPLOYMENT HISTORY
PLEASE LIST THE PAST FIVE YEARS WORK EXPERIENCE BEGINNING WITH YOUR MOST RECENT OR CURRENT EMPLOYMENT
IF SELF-EMPLOYED, PLEASE PROVIDE BUSINESS NAME.
*EMPLOYER NAME: *POSITION:
*ADDRESS: *SUPERVISOR:
     
*City                       * State     * Zip 		*EMPLOYMENT
DATES:		 / / FROM - TO / /
*PHONE: ( )    -  *REASON FOR
LEAVING:

DUTIES, SKILLS, TRAINING, PROMOTIONS DURING THIS EMPLOY:
 
 
EMPLOYER NAME: POSITION:
ADDRESS: SUPERVISOR:
     
City                         State       Zip 		EMPLOYMENT
DATES:		 / / FROM - TO / /
PHONE: ( )    -  REASON FOR
LEAVING:
DUTIES, SKILLS, TRAINING, PROMOTIONS DURING THIS EMPLOY:
 
 
EMPLOYER NAME: POSITION:
ADDRESS: SUPERVISOR:
     
City                         State       Zip 		EMPLOYMENT
DATES:		 / / FROM - TO / /
PHONE: ( )    -  REASON FOR
LEAVING:
DUTIES, SKILLS, TRAINING, PROMOTIONS DURING THIS EMPLOY:
 
*MAY WE CONTACT YOU CURRENT OR MOST RECENT EMPLOYER? Yes No
REFERENCES
PLEASE PROVIDE TWO REFERENCES OTHER THAN FAMILY OR PREVIOUS EMPLOYERS
*REFERENCE NAME: *RELATIONSHIP:
*ADDRESS:    
*City                       *State     * Zip
*PHONE: ( )    -     
*REFERENCE NAME: *RELATIONSHIP:
*ADDRESS:    
*City                       * State       Zip
*PHONE: ( )    -     
ADDITIONAL COMMENTS
PLEASE USE THIS SPACE TO ADD ANY ADDITIONAL COMMENTS, SKILLS, OR INFORMATION THAT YOU BELIEVE IS OF BENEFIT TO THIS APPLICATION
 
*WAS THIS APPLICATION COMPLETED BY YOU ? Yes No      IF NOT, BY WHOM?
 
DIGITAL SIGNATURE...By entering you full name below you acknowledge that the information provided in this application is true and complete to the best of your knowledge. You further acknowledge that in the case of your employment with us, if at any time in the future we find that the information provided in this application is in fact fraudulent or untrue, that we (the employer) have the right to terminate your employment.
 
*ENTER YOUR FULL NAME:
 
 
 

TO SUBMIT YOUR APPLICATION, PLEASE CLICK THE "SUBMIT" BUTTON BELOW

 
 
 

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