FBN***** - Assembler - North Location

Nov *, ****

Personal Information

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** = Conditionally Required Field

Please complete the requested information and click the arrow at the bottom to continue. Contact Information

Legal First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Curtis Legal Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rollins Do you have a middle name? .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes Legal Middle Name ** Roy

Suffix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mr. Mobile Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 630-***-**** Alternate Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Email Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ad0y2q@r.postjobfree.com Address 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 Charles Ave Address 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . St Paul Zip/Postal Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55103 Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States State/Province ** Minnesota

General Information

Are you authorized to work in the country for which you are applying? Yes If no, please describe your work authorization status. ** Have you ever been employed by Daikin Applied? No

If yes, what location? **

From Date **

To Date **

Education History

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** = Conditionally Required Field

To add additional education, click the "Add Education" button below. The "Remove Last Education" will delete all entries for the last employer that you have entered. Please enter your most recent completed education first. Education History

Education 1

Diploma or Degree Obtained .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HS Graduate or Equivalent School/University Name ** Cosmopolitan prep

City ** Chicago

Country ** United States

State ** Illinois

Major . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Graduation Date **

(Not required for High School)

06/15/1984

Last Name while Attending ** Rollins

GPA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Employment History

* = Required Field

** = Conditionally Required Field

To add additional employers, click the "Add Employer" button below. The "Remove Last Employer" will delete all entries for the last employer that you have entered. Please enter your most recent employer first.

Employment History

Employer 1

Employment Type .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Previous Employer ** KFC FASTFOOD

Address 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1536 Robert st. City ** St Paul

Country ** United States

State ** Minnesota

Start Date ** 03/09/2021

End Date ** 04/18/2023

Job Title ** Cook

Reason for Leaving ** Injury on the job / Leave Of Absence May we contact for employment verification? ** Yes To add additional employers, click the "Add Employer" button above. Esignature

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** = Conditionally Required Field

E-Signature

By providing my electronic signature below, I testify that all the information I have submitted throughout the application process is true and correct to the best of my knowledge: ELECTRONIC SIGNATURE: Please type your name as it is listed on your application (i.e. Curtis Roy Rollins):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Curtis Roy Rollins Accepted

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