School Information

Employment Application Form

PLEASE COMPLETE PAGES 1-3.

DATE 2-23-15

Name Henison Gregory

Last First Middle

Present address *** ***** *** ******* **** Ill. 60409

Number Street City State Zip

How long at current address 10

Social Security No. – –

Telephone 708-***-****)

Are you under age 18 YES NO, if “YES”, can you provide proof of your eligibility to work? YES N0

Are you currently authorized to work in the United States? __x__YES NO. Proof of eligibility will be required if hired.

Position applied for (1)Labor

and wage desired (2)

(Be specific)

Days/hours available to work

No Pref Thur

Mon Fri

Tue Sat

Wed Sun No

How many hours can you work weekly? 20-40

Employment desired xqFULL-TIME ONLY qPART-TIME ONLY qTEMPORARY/CONTRACT

When are you available to start work? Now

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

High School

Bro. Rice

Chicago

4 years

General

College

Devry

Chicago

1 year

Computer

Bus. or Trade School

Professional School

Have you ever been convicted of a crime? q No xq Yes (A Conviction record will not necessarily disqualify you from employment.)

Employee Referral? Name

UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, OR PROSPECTIVE EMPLOYMENT OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT.

Please list skills that qualify you for this job: I have experience driving, with delivery, moving, and spotting trailers.

Please list personal attributes: I am reliable,safe,hard working, and honest.

APPLICATION FOR EMPLOYMENT

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES? q Yes xq No

ARE YOU NOW A MEMBER in the ARMED FORCES? q Yes xq No

Specialty Date Entered Discharge Date

Work Experience

Please list your work experience for the beginning with your most recent job held.

If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer Labor Ready

Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code Dolton,Ill.

Phone number

7/31/2001-7/6/2002

Start

Final

Your last job title General labor

Reason for leaving (be specific)The pay was not enough and there was no insurance.

Railroad

City, State, Zip Code

Phone number

4/1999-10/1999

Start

Final

Your Last Job Title Trailer Spotter

Reason for leaving (be specific) The computer was challenging.

Name of employer Self Employed

Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code

Phone number

3/1985-1995

Start 10.00

Final 12.00

Your last job title Mover

Reason for leaving (be specific)

Name of employer U.S. Post Office

Address Chicago.Ill

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code

Phone number

1978-1983

Start

Final

Your last job title Mailroom Worker and Mailman

Reason for leaving (be specific) Laid off

Did you complete this application yourself xq Yes q No If not, who did?

After reviewing the attached job description, please indicate if you are able to perform the essential functions of the job for which you have applied, with or without a reasonable accommodation x_ Yes No.

PLEASE READ CAREFULLY

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age, height, weight, or disability. We assure you that your opportunity for employment with us depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.

Applicant Signature Print Date

Contact this candidate