DOCUMATION

1556 International Drive
Eau Claire, WI 54701

An Equal Opportunity Employer

PERSONAL

First Name

Middle Name

Last Name

Email Address

Phone Number (insert integers only)

Can you legally work in the US?

Yes

Street Address

City

State

Zip Code

Are you 18 or older?

Yes

Position Desired

Wage or salary expected

Full or part-time

Full-time

Part-time

Desired Shift

Have you ever worked here before?

Yes

If so, when?

Date available for employment?

How did you Hear about us?

What prompted you to apply here for employment?

EDUCATION

Please list information referring only to your high school.

High School Name

City

State

Grade Average

Last year completed?

Did you graduate?

Yes

Would you like to add a college or university? Yes No

JOB HISTORY

List present or most recent position first, then next recent, etc. (Include all part-time jobs and military experience.)

Employer's Name

Phone Number

Street Address

City

State

Zip Code

Job Title

Supervisor's name and title

Start Date

End Date

Earnings Start

Earnings End

Full or part-time

Full-time

Part-time

Reason for leaving

May we contact for a reference?

Yes

Describe Duties

Would you like to add another job to your previous experience? Yes No

PROFESSIONAL LICENSES / CERTIFICATIONS

Would you like to add a license or certification? Yes No

REFERENCES

Please list references (not relatives or employees) to contact who are acquainted with your work history.

Reference's Name

Title / Occupation

Company / Address

Phone Number

Would you like to add another reference? Yes No

ADDITIONAL INFORMATION

This section is provided to allow you more space to describe your special skills, abilities, and qualifications. Please take this opportunity to fill it our completely, as it will help us to determine the areas where we could best utilize your talents.

Describe any skills or special abilities you have acquired through your work experience and/or education.

What are your strongest qualifications for work at Documation?

What are your career goals or ambitions for the future?

How would your present or past employer describe you, as an employee?

Final Comments

READ THE FOLLOWING CAREFULLY BEFORE SUBMITTING APPLICATION

I certify that the information contained in this application is true, complete, and correct to the best of my knowledge and belief, and I understand that any falsification or omission of information may cause my immediate dismissal or rejection of this application. I authorize you to obtain information concerning my education, work experience, competence, character, or medical history from the references indicated in this application as it may relate to any position for which I applied. I also understand that in the event I am employed, such employment is at will, permitting me to resign or to be discharged at any time.

I understand that if offered a position with Documation, I may be required to submit to a pre-employment medical examination, drug screening, and background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

I agree to the above conditions

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1556 International DriveEau Claire, WI 54701

An Equal Opportunity Employer

PERSONAL

EDUCATION

JOB HISTORY

PROFESSIONAL LICENSES / CERTIFICATIONS

REFERENCES

ADDITIONAL INFORMATION

1556 International Drive
Eau Claire, WI 54701