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. 7 + 4 = Submit