P.O. Box 3699 Salem, OR 97302



An Equal Opportunity Employer

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Application for employment.

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Personal Information

  Street Apartment Number City State Zip
Present Address:
Permanent Address:
Previous Address: if less then three years
Phone #: Cell #: Are you 18 or older?YesNo Are you legally authorized to work in the US?YesNo
Email: Emergency Contact: Name: Phone #:


Desired Employment

Position: Date you can start: Salary desired:
Are you employed now? YesNo If so may we inquire of your present employer? YesNo
Ever applied with this company before? YesNo Where: When:
Ever worked for this company before? YesNo Where: When:
Reason for leaving:
How did you find out about this position?
Employment Agency Newspaper Advertisement Friend Online Ad
State Employment Office College Placement Services Walk In Other



School Level Name and Location of school No. of Years Attended Did you Graduate? Subjects Studied
High School Yes No
College Yes No
Trade, Business, or Correspondence School Yes No



Subjects of specialty study or research work
Special training, certifications, licenses
Special skills, foreign languages, etc.
Are you a computer or can you fill this box using the blue letters in the picture?

You may not correct this application once submitted