City: State: ZIP Code:
Telephone: Alternate Telephone:
E-mail:
Skills and Qualifications: Summarize any special training, skills, licenses, and/or certificates that may qualify you as being to perform job-related functions in the position for which you are applying.
Computer Skills (Check appropriate boxes. Include software titles and years of experience.) Word Processing Years Spreadsheet Years Presentation Years E-mail Years Internet Years Other Years Other Years
Applicant Statement: I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) cancel further consideration of this application, or (2) immediately discharge me from the employer's service, whenever it is discovered. Do not submit form until you have read the above Applicant Statement.
By submitting this form I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.