Please provide the following applicant information:

Have you ever applied here before?

What position are you applying for?

What date can you start work?

What is your expected pay rate?

Are you presently employed?

Yes No

Please provide the following information about your education:

Select any of the following skills you have:

Typing
File
Operation of Fork Lift
Operation of Heavy Equipment
Painting
Lawn Maintenance
Building Maintenance
Janitorial

Select any of the following computer programs you are proficient in:

Word
Publisher
PowerPoint
Excel
Access
CAD
Corel
QuickBooks
Peachtree
Works

List your last four Employers. Name, Address, Position Held, Pay Rate, Reason for leaving.

Please give us the name of 3 References; Name, Address, Phone, Type of Relationship, Number of years known

Select any of the following options that apply to you in your opinion:

Neatness
Good Character
Trustworthy
Personable
Friendly
Compassionate
Reliable
Dependable
Organized
Easy to talk to
Take Direction Well

Is there any thing else you would like us to consider in looking at this application?

Please read the following statement and to Agree click yes, Disagree no.

"I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they might have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waver does not permit the release or use of disability-related or medical information in a manor prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

Yes No