Clear Visions Inc.

	Employment Application

	First Name
	Middle Initial
	Last Name
	Address
	City
	State
	Zip
	Phone Number
	Email Address
	Fax
	Cellular Number/Pager
	Social Security Number
	Under 18 years old?	Yes No
	If 18, can you provide us with a work permit?	Yes No
	Are you an American Citizen?	Yes No
	If not an American Citizen, are you eligible for employment in the U.S.?	Yes No

	General Information

	What position are you interested in?
	Date available to begin work
	What hours/days/shift?

	Work Experience

	Company 1
	Dates worked
	City
	State
	Position
	What are/were your responsibilities, accomplishments and or achievements?
	Company 2
	Dates worked
	City
	State
	Position
	What are/were your responsibilities, accomplishments and or achievements?

	Military Service

	Are you a veteran?	Yes No
	Dates Served
	Locations Served
	Last rank held
	List what branch you were in and any special skills and training.

	Education

	Community College/ University
	Graduation Date
	City
	State
	Degrees, Majors, etc...

	Community College/ University
	Graduation Date
	City
	State
	Degrees, Majors, etc...

	Training
	Licenses
	Certifications/Awards
	Volunteer Information
	Affiliations/Organizations

	Outline specific responsibilities that you desire in your new job.
	What kind of work do you enjoy?
	What kind of skills/talents will you bring to your new job?

	Computer Skills
	What software programs do you know or have a working knowledge of?
	Have you ever been convicted of a crime?	Yes No
	If so, please explain.