APPLICANT INFORMATION

Last Name		First Name		M.I.
Street Address				Apt/Unit#
City		State		Zip
Phone		Email Address
Date Available		SSN		Desired Salary
Position Applied For
Are you a citizen of the United States?		YES    NO
If no, are you authorized to work in the U.S.?		YES    NO
Have you ever worked for this company?		YES    NO
		If so, when?
Have you ever been convicted of a felony?		YES    NO
		If yes, explain?

EDUCATION

High School		Address
From		To		Did you graduate?	YES    NO
College		Address
From		To		Did you graduate?	YES    NO
Other		Address
From		To		Did you graduate?	YES    NO

REFERENCES

Please list three professional references.
Reference 1
Full Name		Relationship
Company		Phone
Address
Reference 2
Full Name		Relationship
Company		Phone
Address
Reference 3
Full Name		Relationship
Company		Phone
Address

PREVIOUS EMPLOYMENT

Employment 1
Company		Phone
Address		Supervisor
Job Title		Starting Salary
Responsibilities
From		To		Reason for leaving
May we contact your previous supervisor for a reference?					YES    NO
Employment 2
Company		Phone
Address		Supervisor
Job Title		Starting Salary
Responsibilities
From		To		Reason for leaving
May we contact your previous supervisor for a reference?					YES    NO
Employment 3
Company		Phone
Address		Supervisor
Job Title		Starting Salary
Responsibilities
From		To		Reason for leaving
May we contact your previous supervisor for a reference?					YES    NO

MILITARY SERVICE

Branch		From		To
Rank at Discharge		Type of discharge
If other than honorable, explain

DISCLAIMER

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

DISC PROFILE - STYLE ANALYSUS RESPONSE FORM

M    L

M    L

Personal Interest, Attitudes and Values

Personal values are those interests, goals and preferences which guide our lives and careers.

Directions:

There are 12 categories for response, each with 6 items for you to consider. This is not a timed response, but please take only the time you need to complete this form.

Mark your personal preference in each of the 12 areas listed. Rank each of the 6 statements by indicating your choices as follows: Your first choice is 1, your second is 2, etc. For the 12 groups, each (1-6) must be used only once and every box must have a number in it.

Example:

	My Personal Interests are:
6	Independence
4	Joining a group with traditions
3	Appreciation of the beauty of nature
1	Financial security
5	Service to others
2	Knowledge

The Keirsey Temperament Sorter

Choose 1 from each question