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EMPLOYEE INFORMATION:

Last Name First M

Address City Zip

Home # Cell # Email

If necessary for the job are you at least 18 years old? Yes No

Are you legally eligible for employment in the U.S.? Yes No

If the job requires, are you able to lift at least 50 pounds without assistance? Yes No

If needed on occasion, are you able to work overtime and or weekends? Yes No

Do you have a valid Oregon drivers license? Yes No

Do you have a "clean" DMV record (meaning no tickets or accidents)? Yes No

If the answer is no on the a clean DMV record, please explain here:


EMPLOYMENT HISTORY:

Company 1 Contact # Superviser

Address City Zip Start End

Position Reason for leaving

Company 2 Contact # Superviser

Address City Zip Start End

Position Reason for leaving

Company 3 Contact # Superviser

Address City Zip Start End

Position Reason for leaving


EDUCATION:

High school Name Years Completed Graduated Still in School

College/University Years Completed Graduated Still in School

Trade/Tech School Years Completed Graduated Still in School

List any special licenses or skills you have that might pertain to this position.

Are you currently a military reservist? Yes No Are you a Veteran? Yes No

Attach resume here: