Employer: Nelson PaintingPosition Applying For* Personal DataName* First Middle Last Email* Street Address / Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Telephone NumberBusiness Telephone NumberCellular Telephone Number*Date you can start work* MM slash DD slash YYYY Salary Desired* Do you have a High School Diploma or GED?* Yes No Position InformationCheck all that you are willing to work* Full Time Part Time Days Evenings Swing Graveyard Weekends Status* Regular Temporary Are you authorized to work in the U.S. on an unrestricted basis?* Yes No Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?* Yes No Can you perform these essential functions of the job with or without reasonable accommodation?* Yes No QUALIFICATIONS Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training. Schools*School NameDegreeAddress / City / State SPECIAL SKILLS*List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.References*Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated referencesNameAddress / City / StatePhoneRelationship Work History*Start Date (mo/day/yr)End Date (mo/day/yr)Company NameSupervisor’s NamePhone NumberCityStateZipDutiesReason for LeavingStarting SalaryEnding Salary Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS) May we contact your present employer?* Yes No Signature*
