Meadow Lark Agency Career Inquiries

First Name Middle Name Last Name

Please enter your present address:

Please enter your permanent address:

Telephone Number (written in form XXXXXXXXXX)

Federal Law prohibits the employment of unauthorized aliens. All person hired must submit satisfactory proof of employment authorization and identity(valid driver's license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within teh required time shall result in immediate employment termination.

Position Applying For?

Customer Service Rep
Dispatcher
Sales

1. Is there any information we would need about your name or use of another name for us to be able to check your work record? Please specify:

2. Do you have any relatives who are presently (or have formely been) employed by this company?

3. How were you referred to us?

4. Have you ever been convicted of a felony? Yes No

II. Educational History

School Name/Location/Years Completed/Degree/Diploma

Elem/Jr. High

High School

College

Tech Training

Other

III. Employment Record(Please include all employment for the last five years.)

1. Company Name Position Held
Address Dates Employed
Manager/Supervisor Telephone Wage/Salary

Reason for Leaving:

2. Company Name Position Held
Address Dates Employed
Manager/Supervisor Telephone Wage/Salary

Reason for Leaving:

3. Company Name Position Held
Address Dates Employed
Manager/Supervisor Telephone Wage/Salary

Reason for Leaving:

IV. References(Please do not include relatives or former employers)

Name Years Known
Address Telephone
Occupation

Name Years Known
Address Telephone
Occupation

Name Years Known
Address Telephone
Occupation

V. Work Availability

1. What days of the week are you available for an interview?

To select multiple days drag over the days, to select altnernate days Ctrl-click on the days you are available.

2. If your applicaton receives favorable consideration when will you be available to begin work?

How do you prefer to be contacted?

3. Do you have any objection to working overtime? Yes No

4. Can you work overtime without prior notice? Yes No

5. Can you work on Saturday? Yes No

5. Can you work on Sunday? Yes No

6. Can you travel if required by this position? Yes No

VI. Salary/Hourly Rate Agreement

If your application receives favorable consideration, what salary/hourly rate would you require?

Privacy Policy: the information you provide will not be shared it is only for the use in our selection of potential employees.