Franklin Imaging

Employment Application

APPLICATION INFORMATION

First Name Last Name Address 1 Address 2 City State Zip Phone Email Address Date Available What school district do you live in? Are you a citizen of the United States? Yes   No If no, are you authorized to work in the U.S.? Yes   No Have you ever worked for this company? Yes   No If yes, when? Have you ever been convicted of a felony? Yes   No If yes, explain

EDUCATION

High School High School Address Attended from to Did you graduate from high school? Yes   No High School Degree
College College Address Attended from to Did you graduate from college? Yes   No College Degree
Other Address Attended from to Did you graduate? Yes   No Degree

REFERENCES

Please list three professional references.

Full Name Relationship Company Phone Address
Full Name Relationship Company Phone Address
Full Name Relationship Company Phone Address

PREVIOUS EMPLOYMENT

Company Address Phone Job Title Responsibilities Dates of Employment from to Starting Salary Ending Salary Reason for Leaving May we contact your previous supervisor for a reference? Yes   No
Company Address Phone Job Title Responsibilities Dates of Employment from to Starting Salary Ending Salary Reason for Leaving May we contact your previous supervisor for a reference? Yes   No
Company Address Phone Job Title Responsibilities Dates of Employment from to Starting Salary Ending Salary Reason for Leaving May we contact your previous supervisor for a reference? Yes   No

MILITARY SERVICE

Branch Served from to Rank at Discharge Type of Discharge If other than honorable, explain