LANE PRINTING & ADVERTISING

Thank you for your interest in employment with Lane Printing & Advertising. Please fill out the following information:

First Name:
Last Name:
Social Security Number:
Address:
City:
State:
Zip Code:
Phone:
Alternate Phone:
Are you over 18?	Yes No
Position Desired:
Salary Desired:
Date Available:	Yes No
Have you worked for Lane Print before?	Yes No
Have you applied to Lane Print before?	Yes No
Do you have a relative working at Lane?	Yes No
Are you currently employed?	Yes No
Current Employer Reference:
Beginning Date of Employment:
Ending Date of Employment:
Employer Contact Info:
Beginning Salary:
Ending Salary:
Position:
Reason for Leaving:

Beginning Date of Employment:
Ending Date of Employment:
Employer Contact Info:
Beginning Salary:
Ending Salary:
Position:
Reason for Leaving:

Beginning Date of Employment:
Ending Date of Employment:
Employer Contact Info:
Beginning Salary:
Ending Salary:
Position:
Reason for Leaving:

Beginning Date of Employment:
Ending Date of Employment:
Employer Contact Info:
Beginning Salary:
Ending Salary:
Position:
Reason for Leaving:
Do you have any job limitations:
If yes, please explain:
Will you take a physical exam?	Yes No
Will you take a drug test?	Yes No
Highschool attended:
Highschool Location:
Did you graduate?	Yes No
College attended:
College location:
Did you graduate?	Yes No
Major:
Software or other skills:
Reference #1:
Reference #2:
Reference #3:
Special Qualifications: