Contact Information
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First Name
Last Name
Social Security #	- -
Date of Birth  (Optional)	January Feburary March April May June July August September October November December  ---- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
Address
City
State
Zip Code
Phone #1
Phone #2
FAX
E-mail
Applying for Following Position:	Please chose one from list Warehouse Manager Sales Representative Customer Service Foreman Tent Installer Driver / Equipment Operater
Date You Can Start
Are you employed now?	YES NO
May we contact your employer	YES NO
Have you applied here before	YES NO
Education History
High School
Years Attended	From     To:
Did you Graduate	YES No
College or University
Years Attended
Did you Graduate	YES No
Trade School
Years Attended
Subject Studied
Did you Graduate	YES No
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Military Service
US Military Service	No YES
Years Attended
Rank
FORMER EMPLOYERS   (list Last two)
Date:  Month-Year	From     To:
Company Name
Employer Phone #
Salary
Job Description
Supervisor Name
Reason for Leaving
Date:  Month-Year	From     To:
Employer Name
Employer Phone #
Salary
Job Description
Supervisor
Reason for Leaving
REFERENCES:	Give the names of 2 people not related to you, whom you have known for at least three year.
Reference #1
Name
Phone Number
Years Known
Reference #2
Name
Phone Number
Years Known
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AUTHORIZATION
" 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 from Nassau Tent.            I authorize investigation of all statements contained herein and the references and employers listed above to give Nassau Tent any and all information concerning my employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.            I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Nassau Tent representative.            This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."
Questions and comments:

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