Personal Information

Job Interest

Availability

	M	T	W	Th	F	Sat	Sun
From
To

Education/Training

Grade School

Name & Location

Last Grade Completed

1  2  3  4  5  6  7  8

High School

Name & Location

Last Grade Completed

9  10  11  12

Course or Degree

College

Name & Location

Last Grade Completed

1  2  3  4

Course or Degree

Trade or Vocational School

Name & Location

Last Grade Completed

1  2  3  4

Course or Degree

Trade or Vocational School

Name & Location

Course or Degree

References

Please enter personal references, other than employers and relatives.

First Reference

Name

Address

Phone #

Occupation

Years Known

Second Reference

Name

Address

Phone #

Occupation

Years Known

Third Reference

Name

Address

Phone #

Occupation

Years Known

Employment History

Please list all employment, starting with the present or most recent employer.

First Employer

Company Name

Company Address

Company Phone #

Position

Supervisor

Dates of Employment

From Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008  To Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Reason for Leaving

May we contact this employer?

Yes  No

Second Employer

Company Name

Company Address

Company Phone #

Position

Supervisor

Dates of Employment

From Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008  To Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Reason for Leaving

May we contact this employer?

Yes  No

Third Employer

Company Name

Company Address

Company Phone #

Position

Supervisor

Dates of Employment

From Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008  To Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Reason for Leaving

May we contact this employer?

Yes  No

Fourth Employer

Company Name

Company Address

Company Phone #

Position

Supervisor

Dates of Employment

From Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008  To Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Reason for Leaving

May we contact this employer?

Yes  No

Pre-Employment Statement

If employed, I understand and agree that my employment is at-will and can be terminated with or without cause at any time by myself or tanworld. I understand that no one has the authority to enter into any contrary agreements concerning my employment unless such agreement is in writing and signed by the President of tanworld, inc.

I voluntarily give tanworld the right to make a thorough investigation of my past employment and activities, agree to cooperate in such an investigation, and release from all liability or responsibility all persons, companies, or corporations supplying such information.

I understand that a conviction record will not neccesarily be a bar to employment and that factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.

The information that I am presenting in this application is true and correct to the best of my knowledge. I understand that any falsification or misrepresentation herein could result in my discharge in the event that I am employed by tanworld, inc.

I understand that this application will remain active for 30 days for the position I have applied for, and I must reapply to be considered and applicant after the 30 day limit has elapsed.

Please indicate your acceptance of this statement by placing your initals in the field below.