Untitled Document

Application Employement at Cindy Rowe

Windshield Repair

Auto Glass Replacement

Cindy Rowe Dent Repair

left

Position(s) Applied For:

Email Address:

How Did You Learn About Us?

Advertisement	Friend
Inquiry	Employment Agency
Relative	Other

First Name	Middle Name
Last Name

Street Address

City

State

Zip Code

Telephone Number(s)

Social Security Number (voluntary)

Best time to contact you at home is:

If you are under 18 years of age, can you provide required proof of your eligibility to work?			Yes No

Have you ever filed an application with us before? If yes, give date:			Yes No

Have you ever been employed with us before? If yes, give date:			Yes No

Do any of your friends or relatives, other than spouse, work here?			Yes No

If yes, state name, relationship, and location

Are you currently employed?			Yes No

If so, may we contact your present employer?			Yes No

Are you prevented from becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment			Yes No

Date available for work / /		Desired Salary Range

Are you available to work: Full Time Part Time Temporary	(Please Indicate 1 2 3 shift) (Please Indicate Mornings Afternoon Evenings) Please indicate dates available

Are you currently on "lay-off" status and subject to recall?			Yes No

Can you travel if a job requires it?			Yes No

Education


High School	School Name	Course of Study
	School Address	Years Completed
	City, State	Degree / Diploma

Undergraduate College	School Name	Course of Study
	School Address	Years Completed
	City, State	Degree / Diploma

Graduate/ Professional	School Name	Course of Study
	School Address	Years Completed
	City, State	Degree / Diploma

Other (Specify)	School Name	Course of Study
	School Address	Years Completed
	City, State	Degree / Diploma

Work Experience

Start 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.

Employer	Dates Employed
Address	From	To
Telephone Number(s)
Starting/Present Job Title	Hourly Rate/Salary
Supervisor	Starting	Final
Reason for Leaving
Work Performed	May we contact? Yes No

Employer	Dates Employed
Address	From	To
Telephone Number(s)
Starting/Present Job Title	Hourly Rate/Salary
Supervisor	Starting	Final
Reason for Leaving
Work Performed	May we contact? Yes No

Employer	Dates Employed
Address	From	To
Telephone Number(s)
Starting/Present Job Title	Hourly Rate/Salary
Supervisor	Starting	Final
Reason for Leaving
Work Performed	May we contact? Yes No

Employer	Dates Employed
Address	From	To
Telephone Number(s)
Starting/Present Job Title	Hourly Rate/Salary
Supervisor	Starting	Final
Reason for Leaving
Work Performed	May we contact? Yes No

Comments: Include explanation of any gaps in employment.

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

Describe any job-related training received in the United States military.

List professional, trade, business or civic activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status:

Additional Information

Other Qualifications

Additional Information

Terminal	Spreadsheet	Production/Mobile Machinery (list)	Other (list)
PC/Max	Word Processing
Typewriter	Shorthand
Words Per Minute	Words Per Minute

State any additional information you feel may be helpful to us in considering your application.

Note to Applicants: Do not answer this question unless you have been informed about the requirements of the job for which you are applying.

Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activites involved in the job or occupation for which you have applied? Yes No A review of the activities involved in such a job or occupation has been given.

Personal/Professional References Do not include family members or past supervisors.

Name	Phone Number	Best Time to Call	Occupation