Employment Information                                                                                                                                   and Application Form
		This employment application form is intended for use in evaluating your qualifications for employment.           This is not an employment contract. Please answer all appropriate questions completely and accurately.           False or misleading statements during the interview and on this form are grounds for terminating this           application process or, if discovered, after employment, terminating employment. All qualified applicants           will receive consideration without discrimination because of sex, race, color, age, creed, national origin,           sexual orientations, military reserve membership, religion. A felony conviction will not necessarily bar an           applicant from employment. Additional testing of job-related skills and for the presence of drugs in your           body may be required for employment. After an offer of employment, and prior to reporting for work, you           may be required to submit to a medical review. Depending on company policy and the needs of the job,           you will be required to complete a medical history form and may be required to be examined by a medical           professional designated by the company. We verify soc. security numbers upon employment.           Just fill out the application, print (the background color will not print) and           mail to: 1124 Valley Avenue N.W. Puyallup, WA 98371-2503
			Personal Information
		Name
			Are you legally authorized to work in the United States?     Yes No
		Social Security No
		Home Phone
		Message Phone
		Refered by
		Current Address:	How Long?
		Previous Address:	How Long?
		Position(s) desired?
		date you can start?
		Job related skills: certificates or licenses of value to this job application.
			If the job requires, do you have an appropriate valid Washington State drivers license? Yes No
		Name on license:	exp. date:
		Drivers license number:
		Type of license:
		State of issue:
			Have you had any moving violations within 5 yrs?    Yes No
		If yes, please explain:
		Fluent languages?
			Employment Information
		Employer 1
		Company Name
		City / State
		Date Employed	From     To
		Job Title
		Supervisor Name
		Salary	per Hour Week Month
		Phone
		Fax
		Duties
		Reasons for Leaving
			Are you currently working for this employer?  Yes No
			May we contact this employer?  Yes No
		Employer 2
		Company Name
		City / State
		Date Employed	From     To
		Job Title
		Supervisor Name
		Salary	per Hour Week Month
		Phone
		Fax
		Duties
		Reasons for Leaving
			May we contact this employer?  Yes No
		Employer 3
		Company Name
		City / State
		Date Employed	From     To
		Job Title
		Supervisor Name
		Salary	per Hour Week Month
		Phone
		Fax
		Duties
		Reasons for Leaving
			May we contact this employer?  Yes No
			Personal References familiar with your work ethic.   (no relatives)
		Name 1
		Phone
Years Known
Relationship
Name 2
Phone
Years Known
Relationship
	Education
High School
Name
City / State
Graduate?
Degree?
College
Name of college
City / State
Graduate?
Degree?
	Any additional information you would like to provide.
Name
Date
Email Address
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