Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin or handicap.

Please fill out and submit the following application for employment.

A&D Technical Supply Co
Employment Form

NOTE: Bold titles indicate required fields.

Personal Information

First Name:
Last Name:
Middle Name:
Address:
City:
State:
Zip Code:
Home Phone:	(555 123-4567)
Work Phone:	(555 123-4567)
Email:
Pay Expected:	($10.00 p/hr or $35 k p/yr.)
Have you ever applied for employment with us?	Yes No
If yes... When?
Location?
Education College:
Name / Location:
Course of Study:
Years Completed:
Did you graduate?	Yes No
Degree:
High School:
Name / Location:
Course of Study:
Years Completed:
Did you graduate?	Yes No
Diploma:
Elementry School:
Name / Location:
Course of Study:
Years Completed:
Did you graduate?	Yes No
Diploma:
Other:
Name / Location:
Course of Study:
Years Completed:
Did you graduate?	Yes No
Degree or Diploma:
Membership / Organizations Please list your memberships in professional or civic organizations:
(Exclude those which may disclose your race, color, religion or national origin.)
Employment Please provide us with accurate and complete full-time and part-time employmnet records. #1:
Company Name:
Address:
Phone:	(555 123-4567)
Supervisor:
Job title & duties:
Employed (month & year)
Begin:	(MM - YYYY)
End:	(MM - YYYY)
Weekly Pay
Start:
Finish:
Reason for Leaving:
#2:
Company Name:
Address:
Phone:	(555 123-4567)
Supervisor:
Job title & duties:
Employed (month & year)
Begin:	(MM - YYYY)
End:	(MM - YYYY)
Weekly Pay
Start:
Finish:
Reason for Leaving:
#3:
Company Name:
Address:
Phone:	(555 123-4567)
Supervisor:
Job title & duties:
Employed (month & year)
Begin:	(MM - YYYY)
End:	(MM - YYYY)
Weekly Pay
Start:
Finish:
Reason for leaving:
Personal References: #1:
Name:
Address:
Phone:	(555 123-4567)
Business Name:
Years Acquainted:
#2:
Name:
Address:
Phone:	(555 123-4567)
Business Name:
Years Acquainted:
#3:
Name:
Address:
Phone:	(555 123-4567)
Business Name:
Years Acquainted:
List any employers you do not want contacted and why:
Military Service Please complete this section if you served in the U.S. Armed Forces.
Branch of Service:
Rank at Discharge:
Date of Discharge:
Period of Duty (month & year)
Begin:	(MM - YYYY)
End:	(MM - YYYY)
Describe your military duties and any special training:
Please answer the following questions in detail
Why do you want to work with A&D Technical Supply?
Do you have any disabilities that would interfere with your performing the job for which you have applied?
Please describe how your abilities relate to the job for which you have applied:
	By pressing SUBMIT, you hereby declare the information provided by you in this application for employment is true, correct, and complete to the best of your knowledge. You understand that if employed, any misstatement or omission of fact on this application shall be considered cause for dismissal. You authorize us to obtain an investigation consumer report containing information obtained through personal interviews with your neighbors, friends, and acquaintances. This report, if obtained, may include information as to your character, general reputation, personal characteristics and mode of living. You understand you have the right to make a written request within a reasonable period to receive additional detailed information about the nature and scope of any such investigation.