Personal Information
   First Name: required   Last Name: required
Address
   Street:
   City:
   State: Zip:
   Phone: required     e-Mail: required

Employment Desired
   Position Desired: Date you can start:
   Salary desired:
   Are you currently employed:  yes   no    
If yes, may we contact your present employer?  yes  no

General Information
Have you ever been convicted of a felony?   yes   no 
Branch of Military Service:    Rank:

Education
High School Name:
Number of years attended:   Graduate  yes  no 

College (name & location):
Number of years attended:   Graduate  yes   no 
Subjects Studied:

Trade, Business, other:
Number of years attended:   Graduate  yes   no 
Subjects Studied:

Previous Employers
List below the last three employers, starting with the most recent one first.
   Employer #1 -   Name & Address:
  From:   To:
  Position:  Salary:
  Reason for leaving:
 

   Employer #2 -   Name & Address:
  From:   To:
  Position:  Salary:
  Reason for leaving: 
 

   Employer #3 -   Name & Address:
  From:   To:
  Position:  Salary:
  Reason for leaving:
 

References
List the names of three persons not related to you, whom you have known at least one year.
Reference # 1 - Name & Address:
  Business:
  Phone:
  Years known:

Reference # 2 - Name & Address:
  Business:
  Phone:
  Years known:

Reference # 3 - Name & Address:
  Business:
  Phone:
  Years known:

Hiring Policy: I certify that 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 may be grounds for dismissal.

I authorize the company to investigate all statements contained herein and further authorize the company to contact the references and employers listed above to gather information concerning my previous employment and any pertinent information, which may be provided in accordance with applicable federal and state laws, including the Department of Homeland Security and the Social Security Administration.

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 company representative.

I acknowledge that I have read and understand the Hiring Policy, which states that the company will verify the employment eligibility of all newly-hired employees through the Department of Homeland Security and the Social Security Administration. CMR Services Incorporated will only consider for employment an applicant who is 18 years old or older.

By submitting this Pre-Employment Application, I release the company from all liability for any damage that may result from the use of such information.

I agree to the conditions set forth in the Hiring Policy listed above.