(Last, First, Middle Initial) (required)

SS # (LEAVE BLANK UNTIL HIRE)

Address (INCLUDE CITY)

Home Phone Number

EMAIL

Cell Phone Number

Age
 18 or Over

Date of Birth (Month, Day, Year)

Are you employed at this time?
 Yes No

Have you been employed under other names? (If yes, please list names below.)

Have you been employed by our organization?
 Yes No

If yes, please list dates.

Are you related to anyone employed by our organization?
 Yes No

List Name and Relationship.

How did you find out about this job opening?
 Web Page (Employment Opportunity List) Newspaper (Identify) Human Resource Office  Friend  Job Line Other (Please Explain)

Are you authorized to work in the U.S.? (If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.)
 Yes No

Do you have a car?
 Yes No

If Yes, enter model and year.

How long have you been in the sales field?

Have you ever sold advertising?
 Yes No

Have you ever sold on a 100% commission basis?
 Yes No

Do you have any references? (If yes, please list 3 names with phone numbers.)
 Yes No

Name: Phone:

Name: Phone:

Name: Phone:

EDUCATION: Do you have a High School Diploma or GED? PLEASE COMPLETE THE EDUCATION FORM BELOW.
 Yes No

High School/GED - Name & Location of School

# Yrs Completed

Graduated
 Yes No

If No, # credits

Degree/Major

College - Name & Location of School

# Yrs Completed

Graduated
 Yes No

If No, # credits

Degree/Major

Other - Name & Location of School

# Yrs Completed

Graduated
 Yes No

If No, # credits

Degree/Major

SKILLS/LANGUAGES: Write in minimum of 25 words why you want to work with our organization.

Employment History #1 - Dates FROM: (month/year) / TO: (month/year)
List all employment including military and volunteer service starting with the most current position.
You must complete this employment section. This information will be used in reference checks.
Failure to answer all items in the following sections may eliminate you from futher consideration.

Salary Start: $

Salary Final: $

Full Time?
 Yes No

If Part-Time - Enter Hrs/Wk

Position Title

Duties

Organization Name/Address

Supervisor's Name/Title/Phone

May we contact for reference?
 Yes No

Reason For Leaving

Employment History #2 - Dates FROM: (month/year) / TO: (month/year)
List all employment including military and volunteer service starting with the most current position.
You must complete this employment section. This information will be used in reference checks.
Failure to answer all items in the following sections may eliminate you from futher consideration.

Salary Start: $

Salary Final: $

Full Time?
 Yes No

If Part-Time - Enter Hrs/Wk

Position Title

Duties

Organization Name/Address

Supervisor's Name/Title/Phone

May we contact for reference?
 Yes No

Reason For Leaving

Employment History #3 - Dates FROM: (month/year) / TO: (month/year)
List all employment including military and volunteer service starting with the most current position.
You must complete this employment section. This information will be used in reference checks.
Failure to answer all items in the following sections may eliminate you from futher consideration.

Salary Start: $

Salary Final: $

Full Time?
 Yes No

If Part-Time - Enter Hrs/Wk

Position Title

Duties

Organization Name/Address

Supervisor's Name/Title/Phone

May we contact for reference?
 Yes No

Reason For Leaving

SIGNATURE & DATE: Please type your name and date. Doing this certifies that the information and statements above are correct.

"I understand that any false information (or omissions) in this appicaton, or its supporting documents, will be sufficient grounds for refusal to hire me or termination without notice. I further understand that HAUS Corp has the right to review my education, previous employment, driving, and criminal records and other background data."

Your Resume