Personal
Last name:
First name:
Middle name(s):
Street address:
City:
State:
Zip:
Home phone:
Day phone:
E-mail address:
Social security #:
 
Have you ever applied for employment with us? Yes No:
If Yes, month,
year and location:
Position desired:
Pay expected:
 
Apart from religious observance, are you available for full-time work? Yes: No:
 
Will you work overtime if asked? Yes: No:
If not, what hours can you work?
 
Are you legally eligible for employment in the United States? Yes: No:
When will you be available to begin work?
 
Other special training or skills
(languages, machine operation, etc.)
 
How did you learn of our organization?

Education

College
Name and location:
Course of study:
Number of years completed:
Did you graduate? Yes: No:
Degree or diploma:

High School
Name and location:
Course of study:
Number of years completed:
Did you graduate? Yes: No:
Degree or diploma:

Elementary
Name and location:
Course of study:
Number of years completed:
Did you graduate? Yes: No:
Degree or diploma:

Other
Name and location:
Course of study:
Number of years completed:
Did you graduate? Yes: No:
Degree or diploma:

Membership in professional or civic organizations
(Exclude those which may disclose your race, color,
religion or national origin)

Employment

Please give accurate, complete full-time and part-time employment
record. Start with present or most recent employer.

Company 1
Company name:
Address:
City:
State:
Zip:
State job title and describe your work:
Name of supervisor:
Telephone:
Employed (state month and year):
From: To:
Weekly pay:
Start: Last:
Reason for leaving:

Company 2
Company name:
Address:
City:
State:
Zip:
State job title and describe your work:
Name of supervisor:
Telephone:
Employed (state month and year):
From: To:
Weekly pay:
Start: Last:
Reason for leaving:

Company 3
Company name:
Address:
City:
State:
Zip:
State job title and describe your work:
Name of supervisor:
Telephone:
Employed (state month and year):
From: To:
Weekly pay:
Start: Last:
Reason for leaving:

Company 4
Company name:
Address:
City:
State:
Zip:
State job title and describe your work:
Name of supervisor:
Telephone:
Employed (state month and year):
From: To:
Weekly pay:
Start: Last:
Reason for leaving:

Company 5
Company name:
Address:
City:
State:
Zip:
State job title and describe your work:
Name of supervisor:
Telephone:
Employed (state month and year):
From: To:
Weekly pay:
Start: Last:
Reason for leaving:

We may contact the employers listed above unless
you indicate those you do not wish us to contact.

Do Not Contact
Employer name(s):
Reason:

Prospective employees will receive consideration without
discrimination because of race, creed, color, sex, age,
national origin, handicap or veteran status.




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109 Commerce Street • Lake Mary, Florida 32746
(407) 333-COOL

E-mail: info@delair.com

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