Childress Form Childress Commerical Property, Inc. First Name*Middle Name*Last Name*Email Address* Enter Email Confirm Email Present Address*Permanent Address*Are you 18 or older?* Yes No Are you either a U.S. Citizen or an alien authorized to work in the United States?* Yes No Employment Desired* Full-Time Part-Time Position*Date you can start* MM slash DD slash YYYY Salary Desired*Are you currently employeed?* Yes No If so, may we inquire of your present employer? Yes No Have you ever applied to this company before?* Yes No EducationGrammar SchoolHigh SchoolDid you graduate? Yes No Graduation Date MM slash DD slash YYYY College or UniversityDid you graduate? Yes No Date Graduated MM slash DD slash YYYY Trade, Business, or Correspondence SchoolSubjects of special study or research workSpecial SkillsActivitiesU.S. Military or Naval Service* Yes No If yes, What was your rank?Present membership in National Guard or Reserves?* Yes No Previous Employment*Notice: The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.Previous Employer 1Contact NamePhone NumberAddressStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Reason For LeavingPrevious Employer 2Contact NamePhoneAddressFrom Date MM slash DD slash YYYY To Date MM slash DD slash YYYY Reason For LeavingPrevious Employer 3Contact NamePhoneAddressFrom Date MM slash DD slash YYYY To Date MM slash DD slash YYYY Reason for leavingReferencesNamePhoneYears AcquaintedChoose One0-11-23-44-55+NamePhoneYears AcquaintedChoose One0-11-23-44-55+NamePhoneYears AcquaintedChoose One0-11-23-44-55+I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the refernces listed above to give you and and all information concerning my previous employment and any pertinent information they may have and release all parties from all liability fro any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for wages and salary to be determined at any time without prior notice and without cause.* Yes Today's Date MM slash DD slash YYYY Signature*
