INDEPENDENT AIR

Position(s) Applied for: (required)

Referral Source: (required)
AdvertisementEmployeeRelativeWalk-InOther

First Name: (required)

Last Name: (required)

Street: (required)

City: (required)

State: (required)

Zip: (required)

Email: (required)

Phone: (required)

Do you have a clean driving record?
YesNo

If no, please explain:

Have you submitted an application here before?
YesNo

If yes, please give date(s):

Are you legally eligible for employment in this country?
YesNo
(Proof of U.S. citizenship is required)

Are you able to meet the attendance requirements of the position?
YesNo

If no, please explain:

Have you ever been convicted of a felony?
YesNo

If yes, please explain:

(Answering yes does not constitute an automatic bar to employment. Factors such as date of the offense, seriosness/nature of the violation, and position applied for will be taken into account).

Employer:

Dates of Employment

From:

To:

Address:

Starting $/hr:

Ending $/hr:

Title:

Telephone

Supervisor:

Summarize the type of work performed and job responsibilities::

Reason for Leaving:

May we contact for reference?
YesNo

Employer:

Dates of Employment

From:

To:

Address:

Starting $/hr:

Ending $/hr:

Title:

Telephone

Supervisor:

Summarize the type of work performed and job responsibilities::

Reason for Leaving:

May we contact for reference?
YesNo

Employer:

Dates of Employment

From:

To:

Address:

Starting $/hr:

Ending $/hr:

Title:

Telephone

Supervisor:

Summarize the type of work performed and job responsibilities::

Reason for Leaving:

May we contact for reference?
YesNo

Comments:

Please list 3 people not related to you that you have known for at least one year

Name:

Address:

Relationship:

How Long?

Phone:

Name:

Address:

Relationship:

How Long?

Phone:

Name:

Address:

Relationship:

How Long?

Phone:

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