P.O. Box 3699 Salem, OR 97302
(503)339-7512
An Equal Opportunity Employer
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Personal Information
Name:
Street
Apartment Number
City
State
Zip
Present Address:
Oregon
Washington
California
Idaho
Other
Permanent Address:
Oregon
Washington
California
Idaho
Other
Previous Address:
if less then three years
Oregon
Washington
California
Idaho
Other
Phone #:
Cell #:
Are you 18 or older?
Yes
No
Are you legally authorized to work in the US?
Yes
No
Email:
Emergency Contact: Name:
Phone #:
Desired Employment
Position:
Date you can start:
Salary desired:
Are you employed now?
Yes
No
If so may we inquire of your present employer?
Yes
No
Ever applied with this company before?
Yes
No
Where:
When:
Ever worked for this company before?
Yes
No
Where:
When:
Reason for leaving:
How did you find out about this position?
Employment Agency
Newspaper Advertisement
Friend
Online Ad
State Employment Office
College Placement Services
Walk In
Other
Education
School Level
Name and Location of school
No. of Years Attended
Did you Graduate?
Subjects Studied
High School
Yes
No
College
Yes
No
Trade, Business, or Correspondence School
Yes
No
General
Subjects of specialty study or research work
Special training, certifications, licenses
Special skills, foreign languages, etc.
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