Submit an Application

Personal Information

Date: February 08, 2010
* First Name:
* Last Name:
* Address:
* City:
* State:
* Zip:
Home Phone:
Cell Phone:
*Which is your primary number:	Home Cell
* Email:

* Job Applying For:
Date Available:
Income Expected:
Minimum Income Required:

*Employment Preference: Full-Time Part-Time Temporary Other No Preference
Are you willing to work overtime? Yes No
How far would you be willing to commute? (in miles)
Do you have any relatives employed at this company? Yes No
If yes, who?
Have you ever filed an application with us before? Yes No
If yes, when?
* How did you hear about this position?
Referred by:

Are you at least 18 years of age. Yes No
Are you eligible to work in the United States? Yes No

Record of Employment

1. Current/Most Recent Employer
Company Name:
Is this your current employer?	Yes No
May we contact?	Yes No
Your Position:
Telephone:
Address:
City:
State:
Zip:
Dates Employed:	From To (ex: MM/YYYY)
Rate of Pay:	Start End
Supervisor's Name & Title:
Reason For Leaving:
Your Duties:

2. Next Previous Employer
Company Name:
May we contact?	Yes No
Your Position:
Telephone:
Address:
City:
State:
Zip:
Dates Employed:	From To (ex: MM/YYYY)
Supervisor's Name & Title:
Reason For Leaving:
Your Duties:

3. Next Previous Employer
Company Name:
May we contact?	Yes No
Your Position:
Telephone:
Address:
City:
State:
Zip:
Dates Employed:	From To (ex: MM/YYYY)
Supervisor's Name & Title:
Reason For Leaving:
Your Duties:

Education

High School
* Name:
Last Year Completed:	1 2 3 4
* Did you Graduate?	Yes No

College/Technical School
Name:		Major/Courses:
Last Year Completed:	1 2 3 4
Did you Graduate?	Yes No	Date Graduated:
Degree/Certificate:

Other (specify)
Name:		Major/Courses:
Last Year Completed:	1 2 3 4
Did you Graduate?	Yes No	Date Graduated:
Degree/Certificate:

Skills and Qualifications

Please indicate your proficiency in the following:

List additional skills and qualifications:

Please list any languages you speak:

Computer Skills
General Skills	Evaluate your skill level in following areas.
	Power User	Highly skilled	Adequate	Marginal
File Management
Internet
Microsoft Windows
Navigation

Applications	List specific software applications that you know how to use:
Database
Word Processing
Spreadsheets
Presentations
Graphics
Other

References

Reference #1:
Name:		Relationship:
Years Known:		Telephone:
Reference #2:
Name:		Relationship:
Yearks Known:		Telephone:
Reference #3:
Name:		Relationship:
Years Known:		Telephone:

Other Information

Have you ever pled guilty, or no contest to, or been convicted of, a misdemeanor or felony? Yes No
If Yes, please give the date(s) and details:

Have you been arrested for any matters for which you are out on bail or on your own recognizance pending trial? Yes No
If Yes, please give the date(s) and details:

Resume

Cover Letter and/or Text Resume:
	This is optional, but may be requested during interview

Employment Disclosure

I hereby certify all of the foregoing statements are true and correct. I agree to disclose additional or new information, called for by this Employment Application, but known to me only after this Application was completed. I understand that my failure to make such a dis¬closure, and that falsification of any of the information given herein, on any employment form or in any interview or at any time, are grounds for immediate termination, regardless of when such failure or falsification may be discovered.

I authorize TWI Inc to verify my statements and to undertake an investigation to gather and keep as much employment and non-employment information as is permitted by law, and waive any legal requirement to provide notice to me regarding reports or records given or received in accordance with this authorization. Accordingly, all third parties (includ¬ing individuals, schools, businesses, law enforcement authorities, government agencies and consumer reporting bureaus) are authorized to disclose any and all requested information to this prospective employer, and I agree to release all third parties, as well as TWI Inc. and its employees, from any claims arising out of actions taken per these authorizations.

If accepted for employment, I understand that the use of illegal drugs, alcohol and inhalants will be prohibited and I agree to submit to drug testing to detect the use of illegal drugs and alcohol at any time during employment. I also agree to comply with all other company policies, procedures, rules and regulations made known to me at the time of employment or any other times thereafter, and to perform all duties assigned to me to the best of my ability.

I hereby understand and acknowledge that any employment relationship with this organization is of an "at will" nature, which means that I may resign at any time and TWI Inc. may discharge me at any time with or with¬out cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct.

I agree that all information on this application is accurate.

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