DJB Specialties Job Application Form

Full Name*

First NameMiddle NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email Address*

Phone Number*

Area CodePhone Number

Applying for Position*

Desired Pay Range

Are You Currently Employed

Current Employer

Current Employer Address

Current Length Of Employment

Current Salary

Start date

MonthDayYear

1) If hired, can you show proof of your legal right to work in the U.S.?

YesNo

2) Have you ever been dismissed, or asked to resign from any position?

YesNo

3) Have you ever been convicted of a felony or misdemeanor which resulted in imprisonment?

YesNo

If yes to 2 or 3, please explain.

Highest Level of Education

Trade SchoolHigh SchoolCollege

Did you graduate?

YesNo

School Name and Address

Previous Experience

Company

Address

Title

Start Date

MonthDayYear

End Date

MonthDayYear

Job notes, tasks performed and reason for leaving:

Company

Address

Title

Start Date

MonthDayYear

End Date

MonthDayYear

Job notes, tasks performed and reason for leaving:

The following section is to be completed by applicant for an office position:

Can you type?

YesNo

Words Per Minute

Program Knowledge

Excel

NoneAverageExpert

Word

NoneAverageExpert

Outlook Express

NoneAverageExpert

Quickbooks

NoneAverageExpert

PC

NoneAverageExpert

Mac

NoneAverageExpert

Any additional computer and software knowledge:

I certify that all statements made herein and on the enclosed resume are true and correct to the bestof my knowledge. I authorize investigation of all statements herein recorded. I release from liability allpersons and organizations reporting information required by this application

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