PEOPLE'S CARE INC.

* Required Information

Worksite:

Personal Information:

* First Name:
* Last Name:
Middle Name:

* Email Address:
Address:
City:
State:
Zip:
* Phone:
Alternative Phone:
Emergency Contact:

Are you 18 years or older?	Yes No
If hired, can you present evidence of your legal right to work in the United States?	Yes No
Have you ever been convicted of a criminal offense(felony or serious misdemeanor)? (Convictions for marijuana related offenses that are more than two years old need not be listed.)	Yes No
If yes, state nature of the crime(s), when and where convicted, and diposition of the case.

Employment Desired:

Position
Date You Can Start
Salary Desired	$
Are you Employed?	Yes No
If Yes, may we inquire of your Present Employer?	Yes No
Ever Applied to this Company?	Yes No
Where?
When?
Referred By?

Education

*High School*
School Name
Location
Years Completed
Diploma or Degree
Majors or Subjects

*Business School*
School Name
Location
Years Completed
Diploma or Degree
Majors or Subjects

*University*
School Name
Location
Years Completed
Diploma or Degree
Majors or Subjects

*Graduate*
School Name
Location
Years Completed
Diploma or Degree
Majors or Subjects

List any Vocational Schools Attended
List any Professional or vocational certifications, licenses or registrations that you currenty hold or have held in the past.
Describe any specialized training, apprenticeship skills, extracurricullar activities, honors, scholarships, appointments, awards, or special recognition that you have received.

References(List 3 business/professional references who have known you for at least one year.)


*Reference 1*
Name
Business
Phone

*Reference 2*
Name
Business
Phone

*Reference 3*
Name
Business
Phone