Employment Application

MW Clearing & Grading, Inc.

Applicant Information

NAME: Today's Date:

Last First MI

ADDRESS:

Street Address APT. # City State Zip Code

Phone: -- Email:

Date Available: Social Security Number:

Position Applied for: Desired Salary:

Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO

Have you ever worked for this company? YES NO If yes, when?

Have you ever been convicted of a crime? YES NO If yes, please explain?

Education

High School: Address

From : To: Did you graduate? YES NO DEGREE:

College: Address

From : To: Did you graduate? YES NO DEGREE:

Other: Address

From : To: Did you graduate? YES NO DEGREE:

References

Please list three professional references:

Full Name: Relationship:

Company: Phone: --

Full Name: Relationship:

Company: Phone: --

Full Name: Relationship:

Company: Phone: --

Previous Employment

Company: Phone: --

Address: Supervisor:

Job Title: Starting Salary: Ending Salary:

Responsibilities:

Employment from : to: Reason for leaving:

May we contact your previous supervisor for a reference? YES NO

Company: Phone: --

Address: Supervisor:

Job Title: Starting Salary: Ending Salary:

Responsibilities:

Employment from : to: Reason for leaving:

May we contact your previous supervisor for a reference? YES NO

Company: Phone: --

Address: Supervisor:

Job Title: Starting Salary: Ending Salary:

Responsibilities:

Employment from : to: Reason for leaving:

May we contact your previous supervisor for a reference? YES NO

Military Service

Branch: Service from : to:

Rank at Discharge: Type of Discharge:

If other than honorable, please explain:

Disclaimer

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.