| Personal Information |
| Position you are applying for |
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| Today's Date |
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| Full Name |
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| Social Security Number |
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| Home Telephone Number |
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| Business Telephone Number |
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| E-mail Address |
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| Mailing Address (street, city, state, and zip code) |
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| Have you applied at the Columbia Gorge Center before? |
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| If yes, what date(s) and position(s)? |
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| Are you presently on layoff and subject to recall? |
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| Are you available for full-time work? |
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| If no, what days can you work? |
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| Are you legally eligible for United States employment? |
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| If hired, when can you start working for us? |
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| Will you work overtime if asked? |
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| Are you between the ages of 18 and 70? |
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| Do you have a valid driver's license? |
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Have you been convicted of any crimes in the past 10 years? If yes explain
in detail. (Exclude misdemeanors and summary offenses, which have been
annulled, expunged, or sealed by a court.) |
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| Education |
| Did you graduate from high school? |
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| If no, how many years did you complete? |
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| Which high school did you attend (name and location)? |
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| Did you attend a business/trade school? |
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| If yes, which business/trade school did you attend (name and location)? |
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| What did you study at the business/ trade school? |
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| How many business/trade school years did you complete? |
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| What business/trade school certificate did you receive? |
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| Did you attend college? |
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| If yes, which college did you attend (name and location)? |
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| What did you major in while attending college? |
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| What did you minor in while attending college? |
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| How many college years did you complete? |
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| What degree did you receive? |
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Current Memberships in Professional
or Community Organizations |
| Exclude those which may disclose your race, color, religion, or national origin. |
| Organization
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| Membership Activities
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| How long have you been a member? |
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| Organization |
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| Membership Activities |
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| How long have you been a member? |
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| Organization |
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| Membership Activities |
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| How long have you been a member? |
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| Employment History |
Start with your present or most recent employer. Give accurate, complete
full-time and part-time employment history. |
| Company Name |
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| Telephone Number |
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| Address |
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| Month and Year Employment Began |
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| Month and Year Employment Ended |
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| Supervisor's Name |
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| Starting Monthly Gross Wage |
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| Ending Monthly Gross Wage |
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