Option 2 - Fill out an employee application form

Please complete and submit the application below.

General Information:

Your Name:		Email:
Address:		City:
State:		Zip:
Home Phone #:		Alt. Phone #:

	Are you 18 or older?
	If hired can you provide authorization to legally work in the U.S.?
	Have you ever been convicted of a felony or any other crime, including driving under the influence of Alcohol or drugs?
	If yes, please explain with details on; date, city and nature of offense. (Note: a conviction will not necessarily disqualify individuals from employment

U.S. military service duty dates and branch:

From:

To:

Branch:

In case of accident or emergency, I want 1-800-Radiator to notify:
Name:
Phone Number:

Address:

Employment Desired:

Position desired:

Date available for employment:

Salary desired:

Have you ever worked for this company before?

When?:

Where?:

Education:

School	Name	Years completed	Major/field of study	Graduated?	Degree earned?
High School
College/University
Vocational/Business
Do you have office, clerical, computer or information services skills you believe relate to the position in which you are interested? If so please list.

Employment Record:

List your last 4 employers, beginning with the current or most recent. After completing this application you will have the opportunity to submit a resume if you wish.

Employer One:

Employer:		Type of business:
Address:		City/State/Zip:
Supervisor's Name:		Supervisor's Title:
Phone #:
Your Position:
Dates Employed:	From	Rate of Pay:	Start:
	To:		Finish:

	Describe in detail your duties:

Employer Two:

Employer:		Type of business:
Address:		City/State/Zip:
Supervisor's Name:		Supervisor's Title:
Phone #:
Your Position:
Dates Employed:	From	Rate of Pay:	Start:
	To:		Finish:

	Describe in detail your duties:

Employer Three:

Employer:		Type of business:
Address:		City/State/Zip:
Supervisor's Name:		Supervisor's Title:
Phone #:
Your Position:
Dates Employed:	From	Rate of Pay:	Start:
	To:		Finish:

	Describe in detail your duties:

Employer Four:

Employer:		Type of business:
Address:		City/State/Zip:
Supervisor's Name:		Supervisor's Title:
Phone #:
Your Position:
Dates Employed:	From	Rate of Pay:	Start:
	To:		Finish:

	Describe in detail your duties:

Employer Contact:

	May we contact the employers listed above?
	If not, which ones and why not?

References: Please list three references (other than relatives) who have known you for three or more years.

	Name:	Address	Occupation	Phone number	Years known
1
2
3

How did you hear about us?

I, , am agreeing that the information provided is accurate and true and is not false or misleading in any way.