Highco Inc.

Today's date

Last Name

First Name

Middle Name

Street address

Address line 2

City

State StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Home Phone

Telephone

E-mail

Are you a United States Citizen or legally eligible to work in the U.S? (if hired, you will be required to provide documentation that you are eligible to work in the U.S) Are you a United States Citizen or legally eligible to work in the U.S? (if hired, you will be required to provide documentation that you are eligible to work in the U.S) Yes No

Date Available to Work

Are you18 or over? Are you18 or over? Yes, I'm over 18 years old. No, I'm not over 18 years old.

Title of the position Applying for:

Have you been previously interviewed or employed by the Highco? Have you been previously interviewed or employed by the Highco? Yes No

List the date(s) and job(s) title:

Do you have any relatives working for the Highco? Do you have any relatives working for the Highco? Yes, I do. No, I don't.

List the names and relationship to you:

Are you employed now? Are you employed now? Yes, I am. No, I am not.

May we contact your present employer?

High School High SchoolYesNo

Complete information about High School, such: # Years completed, Major Area of Study and Degree/Diploma.

Employment History

Please provide the following information for your previous three employers, Begining with the most recent.

Employer

From

To

Job Title

Address (full)

Telephone

Weekly Pay Start:

Weekly Pay Finish

Reason for Leaving

Job Duties:

Employer

From

To

Job Title

Telephone

Address (full)

Weekly Pay Start:

Weekly Pay Finish

Reason for Leaving

Job Duties:

Employer

From

To

Job Title

Address (full)

Telephone

Weekly Pay Start:

Weekly Pay Finish

Reason for Leaving

Job Duties:

Describe your qualifications for the type of employment you are seeking: (Include skills, special training, etc.)

References

Please list names of supervisors, managers, or others who can comment directly on your abilities:

Name

Address

Phone

Relationship

Years known

Name

Address

Phone

Relationship

Years known

Name

Address

Phone

Relationship

Years known

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if employed, false statements on this application shall be considered sufficient cause of dismissal. You are hereby authorized to make investigation of my personal references.