Personal Information:

First Name:      Last Name:    Middle Initial: 

Social Security Number:      

Street Address:  City:  State:  Zip Code:

Telephone:       Cell Phone:       E-mail: 

Previous Employment (most recent employer first):

Employer #1:       Position: 

Employer Address:       Salary: 

City:  State:  Zip Code:     Dates Employed: 

Employer #2:       Position: 

Employer Address:       Salary: 

City:  State:  Zip Code:     Dates Employed: 

Employment you are seeking:

Type of Employment Desired:  Full Time     Part Time     Temporary     Internship

Position Desired:    Sales     Service     Clerical / Administrative     Collision Repair

                            Other: 

Date Available for Work:       Desired Salary: 

Are you legally eligible for employment in the United States?  No     Yes

Have you ever plead "Guilty", "No Contest", or been convicted of a crime?  No     Yes