First Name: Last Name:

Address: City: State: Zip:

Phone: Email:

Social Security Number:

Date Available for Employment:

If employed and under 18, can you furnish a work permit? Yes No

Have you ever been employed by this company? Yes No

If yes please give date (s): to

Are you employed now? Yes No

If yes how much notice will your present employer require:

May we contact your present employer? Yes No

If yes, give name: Phone number

Type of work desired or position applying for:

If applying for a position where driving is required:

Do you have a valid drivers license in the State of Tennessee? Yes No

Drive’s license number:

Can you perform the essential functions of the job(s) for which you are applying? Yes No

Are you available to work: FULL-TIME PART-TIME OVER-TIME

Have you been convicted of a felony? Yes No
(Please note that a “YES” answer will not bar you from consideration for employment)

If YES, please explain including state in which convicted:

ELEMENTARY High School COLLEGE GRADUATE

Last School Attended
NAME YEARS

Grades Completed 4 5 6 7 8 9 10 11 12

College: Some College Associates Degree Bachelor's Degree Master's Degree none   Course of Study:

Additional schooling / certifications:

REFERENCES:

List three (3) non-relatives who are familiar with your qualifications and actual work history and ability.

1. Name: Occupation: Relationship: Years Known: Phone:

2. Name: Occupation: Relationship: Years Known: Phone:

3. Name: Occupation: Relationship: Years Known: Phone:

EMPLOYMENT EXPERIENCE:
Start with your present job or last job. List your last four (4) jobs in order. Do not omit any job.

Employed from to: Employer Supervisor:

Address: Phone:

Position held: Salary: Starting: Ending:

Duties:

What did you like most about your job or least about your job:

Reason for leaving:

Employed from to: Employer Supervisor:

Address: Phone:

Position held: Salary: Starting: Ending:

Duties:

What did you like most about your job or least about your job:

Reason for leaving:

Employed from to: Employer Supervisor:

Address: Phone:

Position held: Salary: Starting: Ending:

Duties:

What did you like most about your job or least about your job:

Reason for leaving:

Employed from to: Employer Supervisor:

Address: Phone:

Position held: Salary: Starting: Ending:

Duties:

What did you like most about your job or least about your job:

Reason for leaving:

COMPUTER EXPERIENCE / KNOWLEDGE:

I FEEL MY STRENGTH LIES IN MY ABILITY TO:

I FEEL MY CO-WORKERS WOULD DESCRIBE ME AS:

I FEEL MY WORK RELATED WEAKNESSES ARE:

1. Recall an incident where you made a major mistake. What did you do after the mistake was made? What did you learn from this mistake?

2. Tell us about a pressure situation you were in that would demonstrate your ability to work under pressure.

3. You are buying a bike for you son at Wal-Mart and it is priced at $99.00. When you go to check out, it rings up for $79.00. What would you do?

4. What can you add to what we have already asked you that should make us want to hire you?

I certify that all answers and statements I have made on this application (and resume or other supplementary materials) are true and complete without omissions. I understand that any false information will result in refusal to hire or immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character, and qualifications.

Signature: Date: