DATE:

Name
Last: First: Middle:

Maiden:

Present Address
Address: City: State: Zip:

How Long?                                                        

Telephone:                                                         Email Address:

What is the best way for us to contact you?

Position applied for (1) (Be specific)

Salary desired (2) (Be specific)

Employment desired: FULL-TIME ONLY PART-TIME ONLY FULL-OR PART-TIME

List the dates you are available for work:  

EDUCATION

Type of School: High School College Bus. Or Trade School Professional School    Name of School:  

Number of Years Completed:

Location: (Complete Mailing Address)
 Address: City: State: Zip:

Major & Degree:

Type of School: High School College Bus. Or Trade School Professional School    Name of School:  

Number of Years Completed:

Location: (Complete Mailing Address)
 Address: City: State: Zip:

Major & Degree:

WORK EXPERIENCE
Please list your work experience for the past five years beginning with your most recent job held.  If you were self-employed, give firm name.

Name of employer:

Address: City: State: Zip:

Phone Number:   Name of last supervisor:

Employment dates:  From To

Pay or salary:   Start    Final

Your last job title:

Reason for leaving (be specific)

List the jobs held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of employer:

Address: City: State: Zip:

Phone Number:   Name of last supervisor:

Employment dates:  From To

Pay or salary:   Start    Final

Your last job title:

Reason for leaving (be specific)

List the jobs held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of employer:

Address: City: State: Zip:

Phone Number:   Name of last supervisor:

Employment dates:  From To

Pay or salary:   Start    Final

Your last job title:

Reason for leaving (be specific)

List the jobs held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of employer:

Address: City: State: Zip:

Phone Number:   Name of last supervisor:

Employment dates:  From To

Pay or salary:   Start    Final

Your last job title:

Reason for leaving (be specific)

List the jobs held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact your present employer? YES NO

Did you complete this application yourself? YES NO   If not, who did?

MEANS OF TRANSPORTATION

DO YOU HAVE A DRIVER'S LICENSE? YES NO

What is your means of transportation?

REFERENCES

Please list two references other than relatives or previous employers.

Name: Position: Company:

Address: City: State: Zip:

Telephone:

Name: Position: Company:

Address: City: State: Zip:

Telephone:

PLEASE READ CAREFULLY
APPLICATION FORM WAIVER

In exchange for the consideration of my job application by A.I.S., Inc. (hereinafter called "the Company"), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of A.I.S., Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that the relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company.  Both the undersigned and A.I.S., Inc. may end the employment relationship at any time, without specified notice or reason.  If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application.  I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice.  I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liabilities as a result of such contract.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living.  Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of such report requested by it, as required by the Fair Reporting Act.

Signature of applicant:       Date:

By typing my name in the signature box above I understand that this is regarded as a valid signature of contract.

Thank you for completing this application form and for your interest in our business.