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summ9t State&Federal Law Prohibits ISKIitEn 1RAnE3 AN EQUAL OPPORTUNITY EMPLOYER Discrimination Based On Age Sex or National Orgin ' NAMfFIAST,FIRST MIDDLE I)� ) _ SOCIAL SECURITY NUMBER _ t)ATi C)T R'ATH �=~H m �l O:FI[e Use Flniu /j /J �• 1 f ; 1-90 W-40 Cop aC1.D.'s C1 57 STREET AyDRCSS r f1JrUj }�s L1 M• n j Drv;&Akohal cJ ! ! ! %•��s �f �f y C...`, --- -- (_. Lrr f Lmpluyce Handbooks HOMmICNI: .i M 81 LE PHONE LMAII A10F455 '-Vnrr-0 woo IN us AULN AEC>t 1j....Y.HE.'EYP OATS nnfid ntWltyJ '1 r V.- [nnBdenlWlftyU t = r S 55 YES R NU ' � �-� 1= � ^T uanaRls4] Cllenl Eentllts WaWerU -- IH E Of RIFRGINCY,NOTFTY-NAfll: ! AORHE33 TELEPHONE 7 Marital Slaty + .T .... �! r I r ;1 �. �. / j �• ,� ❑ManicdLlVluorfrd�.�,—F� w_ 4'1 1 1lf" I�r r l k�C1 1'--- I�JyL4 �` � '-Op--�.I WlIAT POSITION ARE YOU APPLYING TOIL OAT EAYAtV.tF[f. r.171 RAT?PHI ffn VAIA YOV EVLA T1rTN .If. .�L`nV (r CONVICTED OF A FELONY? •JINf� l'v 1 ��^ ��4\ IFa YES �{.HO_—_-- __ _—c�T✓� r HOW UID YUUFLEAR Of US? Haut you cvar worked fo '� rpmlt r SpL: V[LSWt6t{Aplknal]: flat c:{]GULaslan Ll Allan TJ AFrI[az•An:u:ranfEladl tt SkMediladeshriare?[ Mate / 1" ❑HRpmIL/LallnnClAm rltentndlan/AlaekanN&tljr 1 # ftt.I}'l $4 .. /� 1ti1i !4 f TELT /.11rfrLr�I'? + ,fjo ±IT ? _ /�J GLNlELaT1,11trslS3fik S21lle[IQPFQVI„,,, TF.1_.�..___-._..�c.�i...' 'IIDAYSARE YOU AyAII'ApLE TO WORK rU,L iME CITIES AVA'IAaLETO WORK IN ).! 15r51L1TT f�'H rIK I 'VI lLI AVAIL AEI-f LU)1C;TF,lir.l i:.S:iiGll?1EIS rAaN G'ru�yiW�p,t�THLi �I�I �A�. SL1N `�-i/� l R.2NUSI:IFT `�AkFTO h1 UWil-LACCEPT SAME DAY ASS;GNMENT WORT(SKILL-Check your skills and kind'of Work you haveuonF. J .11D ql l:r, A&I TO Pr, til TRANSPCIITTION A rAll A!f1 E^J YC-t; IJq U AUSALNISTRATIVEASSISTANT J ELE.CTRICIAM U IIVACIIF''._'F.li Lt IIVACJOURNEYMAN 1L'SHF.ETVFTAL EQUIPIArNT UrWerSLkun:Ci' U CI.ECTRII�,',' t1E11'i R J ELECi14CAI AI;PRU4nCt U IIVAC.Ll.bJHFR J 1IJAC SERVICE TECH /U SIIEET 1.17TAL AWrIENTICF: L! lia:d Ilot U YES L)710 U FLLe:i01L.ALJOURNFY14AN J FLLCIR1CAt.MALFER J UOUlf'F-ViT GGYR _1 LQUiF'PdLNTOPLRATORAP:-MiTICF 1.1 ;Ur[Tmrrm NGw-m U Tcafj LICENSE NUMBER. U LOW VOL TAGV E,tECTR1CIAN U ELECTRICAL LABOIIEH U EQUIPFJfHT OPERAT t GLNERAL LABORER U 51417ET Mr.TAL JOI)MIFYRIAN U Glasses FJ MACHINE APP UL MACHDII;I U PLUFAULN J PLLJIA13CRR APPRENTICE U SHEET!.!ETAI.MASTER U steol Tae YYulk Twat, :.1 CDL LI MACHINE MCIIJT MAKLH sa MACH:tIE QPI HATOR Ll P!_uthA H ELLPE li ,.1 I'LUMULF2 JOURNEYRIAN Lt SHEET METAI !AUVW I.1 CJ,ur(Fic7-,0 list): U Cla$5 A Ll IJAC141UIST LAHDRI.11 U MACHIIIV OILER L) PLU.'JOEII I.A60REFI J PLUMLIM MASTER U Y.TLOER ❑ Glass TS El MACIIINF.1001.AND Oir.MAKER J bMArH111-IDOL AND I) J PIPEI iTTLF- -1 PI CEIITI4RAPPRVN11C4 U 1YrLDCR FLAT U MAINTr::A!ICFLVOFR( J MAI_LIF-ACIUiINGLABOR It J MPFI-11 L.tlli_'_11I.J PIPI-.i%"TFf?JOURNM!AN L) %WLBER!;ROf'rrt U HVAC J 13VAC APPRI NME U PIPCf IT`f II LABOF J 11PEE1TTER MASTER U CIPHER Previos Employment Name of Employer Phone or Address Isupervisors Pair r.,-^ 1P Reason I rom F' !Yj �• /C ,C r 'j, j, �� i !� t !yf Z '17 ro! ' 1 U}t .0 ! Education Name of School Degree Graduated? List all Licenses and Certifications Expirati n Date l hereby authorize you and all former Vmplayers,and ct hers given by me as a reference, to answer all questions and to give all information in connection with this application or in any way concerning me. I agree, if er:ployed by you, tho' i`over I make claims against you for personal injuries, upon your request i shall submit to drug screens and examinations by physicians of your selection.Your employment of me may be terminated by you at any time without any liability to me except for wages and salary as have been earned by me at the date of such termination. I understand that it is my responsibility to nolif you of my availability on a weekly basis at a minimum,and if 1 do not, I will considered unavailable for work. Signature: C = C. G--- Date: