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KillerGrafix, Inc. Application Part 1 Prospective applicants will receive consideration without discrimination because of race, color, religion, sex, age, national origin, marital or veteran status, non-job-related medical conditions or handicaps, or any other legally protected status.     Date of application: Date available for employment: Position(s) applied for: How did you hear about this position? Newspaper Friend Relative Walk-in Employment Agency Other Job Code:   General Information Name (Last, First Middle): Address: City: State: Zip: Telephone: Social Sercurity Number (optional):     If employed and under 18, can you furnish a work permit? Yes No Are you currently employed? Yes No May we contact your present employer? Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.) Yes No   Please check the category that best summarizes your available hours:     Full-Time Part-Time Temporary   Can you travel if the job requires it? Yes No Are you on lay-off and subject to recall? Yes No Have you been convicted of a felony within the last five years? Yes No      If "yes" explain:       Are you a veteran of the U.S. Military? Yes No      If "yes" specify branch:   Was your discharge other than honorable? Yes No       If "yes" explain:     KillerGrafix, Inc. Application Part 2   Education School Name, Location Years Completed/ Degree Course of Study High School College/University Graduate/Professional Outline specialized training, apprenticeships, internships, skills, and extracurricular activities:   Honors received: State any additional information you feel may be helpful to us in considering your application. If necessary, please use a separate sheet of paper.   List professional, trade, business, or civic activities, and offices held (you may exclude memberships that would reveal sex, race, religion, national origin, ancestry, handicap, or other protected status).   List name, address, and phone number of three references who are not related to you and are not previous employers.     Name Address, City and State Phone Number 1. 2. 3.   Briefly summarize special skills and qualifications you have from your employment or other experiences.   Do you speak a foreign language? If so, please list the language that you speak and your ability to read and write in that language.   KillerGrafix, Inc. Application Part 3   Employment History   Please give an accurate employment record, filling out all sections completely, beginning with your present or last job.   Employer Dates Employed Name: Telephone: Address: City: State: Zip: Job Title: Supervisor: Reason for Leaving: From: To: Hourly Rate/Salary Starting: Final: Work Performed:   Employer Dates Employed Name: Telephone: Address: City: State: Zip: Job Title: Supervisor: Reason for Leaving: From: To: Hourly Rate/Salary Starting: Final: Work Performed:   Employer Dates Employed Name: Telephone: Address: City: State: Zip: Job Title: Supervisor: Reason for Leaving: From: To: Hourly Rate/Salary Starting: Final: Work Performed:   Agreement   By checking the box below, I agree that the information provided in this employment application is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in dismissal. I authorize you to engage a consumer reporting agency to investigate my credit and personal history. If a report is obtained, you must provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of the report. I understand that an offer of employment does not create a contractual obligation upon employer to continue to employ me in the future.   I Agree Email: