Employment Application

Please provide the following contact information:

First Name
Last Name
Middle Initial
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Please describe yourself:

Date of Birth
Sex	Male Female
Height
Weight
Social Security Number

Enter your Drivers License Number

Are you at least 18 years old?

Yes No

Do you have the right to remain permanently in the U.S. and do you have authorization to work in the U.S.?

Yes No

Have you worked under a different name before?

Yes No

If yes, explain:

Position applied for:

Date available:

-- mm/dd/yy

How did you learn about this opening?

Times you can work:

Morning
Noon
Night
Weekends
No restrictions

Are you presently employed?

Yes No

If yes, where:

Are you subject to recall at another job?

Yes No

If yes, explain:

Have you ever applied to Grant Tower, Inc. before?

Yes No

If so, when:

-- mm/dd/yy

What position?

Wage expected:

Are you related to or do you know anyone who currently works for Grant Tower, Inc.?

Yes No

If yes, please name the individual(s):

Education

High school name and location

Course of study

Years completed:

Did you graduate?

Yes No

Diploma or Degree:

Grade point average:

College name and location:

Course of study:

Years completed:

Did you graduate?

Yes No

Diploma or degree:

Grade point average:

Trade School name and location:

Course of study:

Years completed

Did you graduate?

Yes No

Diploma or degree:

Grade point average:

Other formal education or experience which you feel is relevant to the position for which you are applying for:

Employment History

Employer 1

Name and address

Position

Starting salary

Ending salary

Description of duties

Supervisor's name

Employed from:

-- mm/dd/yy

Employed to:

-- mm/dd/yy

Reasons for leaving

Employer 2

Name and address

Position

Starting salary

Ending salary

Description of duties

Supervisor's name

Employed from:

-- mm/dd/yy

Employed to:

-- mm/dd/yy

Reasons for leaving

Employer 3

Name and address

Position

Starting salary

Ending salary

Description of duties

Supervisor's name

Employed from:

-- mm/dd/yy

Employed to:

-- mm/dd/yy

Reasons for leaving

Background

Have you ever been convicted of a crime?

Yes No

If yes, state the crime(s)

Are any felony charges currently pending against you?

Yes No

If yes, explain:

Do you have a valid drivers license?

Yes No

If yes, which state(s)

Do you have a CDL certificate?

Yes No

If yes, what class?

What other employment or "sideline" business do you have?

Would you want to continue the "sideline" business if employed by us?

Yes No

References

Reference 1

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone

Reference 2

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone

Reference 3

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone