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APPLICATION FOR EMPLOYMENT

We are an equal opportunity employer, dedicated to the policy of non-discrimination in employment on any basis including race, color, age, sex, religion, handicap or national origin.

PERSONAL INFORMATION
Name:
Address:
City:
State:
Zip Code: 
Phone Number:
Referred By:
Date Of Birth:

EMPLOYMENT DESIRED
Position:
Date You Can Start:
Salary Desired:
Are You Employed Now?
If So, May We Contact Your Employer?
Have You Ever Applied To Our Company Before?
If So, Where And When?

EDUCATION
High School:
Graduation Date:
College:
Subjects Studied And Degree(s) Earned:
Trade School
Subjects Studied And Degree(s) Earned:
Please List Any Additional Special Study Or Research Work
Please List Any Job Related Skills:

CURRENT AND FORMER EMPLOYERS

List Below Your Last Four Employers, Starting With The Last/Present One First
Name Of Employer:
Address Of Employer
Dates Of Employment::
Position
Salary
Reason For Leaving/Seeking Other Employment:
Name Of Employer:
Address Of Employer
Dates Of Employment::
Position
Salary
Reason For Leaving:
Name Of Employer:
Address Of Employer
Dates Of Employment::
Position
Salary
Reason For Leaving:
Name Of Employer:
Address Of Employer
Dates Of Employment::
Position
Salary
Reason For Leaving:

Additional Comments

*IMPORTANT, READ BEFORE SUBMITTING THIS APPLICATION:

I hereby certify that I personally completed this form and that the information is true, correct and complete, to the best of my knowledge.  I authorize Wabash Mutual Telephone to obtain information relating to my past or present work history and to do a complete background investigation in accordance with state and federal laws.    Furthermore, I give my express consent for Wabash Mutual Telephone and previous employers, their agents, or Medical Review Officers or their agents, to release information concerning any of my past controlled substance tests.  I release all persons from any liability or damages.  I authorize release of any information, including all information related to my alcohol and controlled substances testing and training records, by any former employers and hold them harmless of any liability from release of said information.