STL

Last Name

First Name

M.I.

Date

Street Address

Apartment/Unit #

City

State

ZIP

Phone

E-mail Address

Date Available

Desired Salary

Are you a citizen of the United States?

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

Have you ever worked for this company?

Yes

No

If so, when?

Are you willing to relocate?

Yes

No

Are you willing to work overtime and/or weekends?

Yes

No

Have you purchased products from STL?

Are you looking for full-time employment?

Yes

No

If no, what hours are you available?

Do you know anyone working or has worked for SpeedTech Lights, Inc.?

Yes

No

If yes, please list.

Have you ever been convicted of a crime?

Yes

No

If yes, explain

Do you have a reliable form of transportation?

Yes

No

If yes, explain

High School

Address

From
To

Did you graduate?

Yes

No

Degree

College

Address

From
To

Did you graduate?

Yes

No

Degree

Other

Address

From
To

Did you graduate?

Yes

No

Degree

Full Name

Relationship

Company

Phone

Full Name

Relationship

Company

Phone

Full Name

Relationship

Company

Phone

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

From
To

Reason for Leaving

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

From
To

Reason for Leaving

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

From
To

Reason for Leaving

Branch

From
To

Rank at Discharge

Type of Discharge

Signature

Date

Employment Application

APPLICANT INFORMATION

EDUCATION

REFERENCES Please list three professional references.

PREVIOUS EMPLOYMENT

MILITARY SERVICE

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