Personnel Record & Application (W.I.T. Development)

Note: Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Employment History

Please provide the following information for your previous three employers, beginning with the most recent: (Please attach an additional page if necessary, do not use "see attached resume".)

---Employment History 1---

Dates Employed:

Weekly Pay:

---Employment History 2---

Dates Employed:

Weekly Pay:

---Employment History 3---

Dates Employed:

Weekly Pay:

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigation and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or individuals from all liability when responding to inquiries in connection with my application. In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

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