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    creativeedge header - all info
     
        DATE  
    PERSONAL INFORMATION  
     
    NAME   PHONE NUMBER #1  
      LAST FIRST MIDDLE   PHONE NUMBER #2  
     
    PRESENT ADDRESS  
      STREET APT.# CITY STATE ZIP  
                                                                                               
    PERMANENT ADDRESS  
      (IF DIFFERENT)   STREET APT.# CITY STATE ZIP  
                                                                                               
    DRIVER'S LICENSE NUMBER     STATE   TYPE            
                                                                                 
    SSN     DATE OF BIRTH   HEIGHT ' "   WEIGHT  
       
    PLEASE CHOOSE ONE OF THE FOLLOWING:  
                                       
      IF OTHER, PLEASE EXPLAIN        
                                                                                               
    NUMBER OF CHILDREN     DEPENDENTS OTHER THAN WIFE OR CHILDREN            
                                                                                               
    PLEASE CHOOSE ONE OF THE FOLLOWING:  
           
      IF PERMANENT RESIDENT, ENTER ALIEN #                        
      IF ALIEN AUTHORIZED TO WORK, ENTER ALIEN # OR ADMISSION #        
      UNTIL (EXPIRATION DATE, IF APPLICABLE - MONTH/DAY/YEAR)    
      IF OTHER, PLEASE EXPLAIN    
                                                                                                                     
     
    EMPLOYMENT DESIRED  
     
    POSITION APPLIED FOR:  
    FIRST CHOICE     YEARS EXPERIENCE  
    SECOND CHOICE   YEARS EXPERIENCE  
     
    LIST SPECIAL SKILLS OR EQUIPMENT USED--YEARS OF EXPERIENCE:  
       
     
    HAVE YOU WORKED FOR THIS COMPANY BEFORE?
      WHERE?  
    DATES:  FROM TO   RATE OF PAY   POSITION  
     
    ARE YOU CURRENTLY EMPLOYED?  
     
    IF NOT, HOW LONG SINCE LAST EMPLOYMENT?  
                                               
    HAVE YOUR WAGES EVER BEEN GARNISHED?  
                       
     
    WHO REFERRED YOU?   RATE OF PAY EXPECTED  
                                                                                                                     
     
    FORMER EMPLOYERS: (LIST BELOW YOUR LAST 3 EMPLOYERS, STARTING WITH THE MOST RECENT)  
     
    FROM:   EMPLOYER NAME    
    TO:     ADDRESS    
      TELEPHONE #    
      SALARY     POSITION  
      REASON FOR LEAVING    
     
    FROM:   EMPLOYER NAME    
    TO:     ADDRESS    
      TELEPHONE #    
      SALARY     POSITION  
      REASON FOR LEAVING    
     
    FROM:   EMPLOYER NAME    
    TO:     ADDRESS    
      TELEPHONE #    
      SALARY     POSITION  
      REASON FOR LEAVING    
                                                                                                                     
     
    REFERENCES:  GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE  
      KNOWN AT LEAST ONE YEAR  
     
    1 NAME    
      ADDRESS    
      BUSINESS    
      YEARS ACQUAINTED     TELEPHONE #  
       
    2 NAME    
      ADDRESS    
      BUSINESS    
      YEARS ACQUAINTED     TELEPHONE #  
       
    3 NAME    
      ADDRESS    
      BUSINESS    
      YEARS ACQUAINTED     TELEPHONE #  
                                                                                                                     
                                                                                                                     
    HAVE YOU EVER BEEN CONVICTED OF A FELONY?  
     
    HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR?  
     
    IF YOU ANSWERED YES TO EITHER CONVICTION, EXPLAIN IN DETAIL BELOW:  
     
    DATE     WHERE  
    NATURE OF CONVICTON    
    RESULTS  
     
    DATE     WHERE  
    NATURE OF CONVICTON    
    RESULTS  
                                                                                                                     
                                                                                                                     
    HAVE YOU EVER SERVED IN THE U.S. ARMED FORCES?
      BRANCH  
    DISCHARGE DATE RANK AT DISCHARGE   TYPE OF DISCHARGE  
                                                                                                                     
                                                                                                                     
    PHYSICAL RECORD  
       
    WHEN WAS THE LAST TIME YOU HAD A PHYSICAL EXAM?    
    HAVE YOU EVER HAD A PHYSICAL EXAM IN THE LAST FIVE YEARS?    
    DO YOU AGREE TO TAKE A PHYSICAL EXAM IF ASKED BY CREATIVE EDGE?
     
     
    HAVE YOU EVER HAD AN INJURY THAT COULD AFFECT YOUR ABILITY TO WORK?
     
    IF YES, DESCRIBE CIRCUMSTANCES AND OUTCOME OF INJURY IN DETAIL BELOW:  
     
    1 NATURE OF INJURY    
      EMPLOYER WHEN INJURED    
      YEAR OF INJURY   ATTORNEY EMPLOYED, IF ANY  
       
    2 NATURE OF INJURY    
      EMPLOYER WHEN INJURED    
      YEAR OF INJURY   ATTORNEY EMPLOYED, IF ANY  
       
    3 NATURE OF INJURY    
      EMPLOYER WHEN INJURED    
      YEAR OF INJURY   ATTORNEY EMPLOYED, IF ANY  
                                                                                                                     
    WILL YOU ABIDE BY THE SAFETY RULES OF CREATIVE EDGE?
     
    WILL YOU INFORM THE COMPANY IN WRITING OF SAFETY VIOLATIONS?
     
    IF INJURED, WILL YOU ACCEPT THE MEDICAL FACILITIES RECOMMENDED BY YOUR EMPLOYER?
     
                                                                                                                     
                                                                                                                     
    POLICY APPROVALS  
    CLICK ON THE LINKS BELOW TO VIEW EACH OF OUR POLICIES.  CHECK THE BOX TO THE LEFT OF A
    LINK TO STATE THAT YOU AGREE TO THAT POLICY.
    POLICY STATEMENT
    DRUG AND/OR ALCOHOL TESTING POLICY
    DRUG-FREE WORKPLACE POLICY
                                                                                                                     
                                                                                                                     
    NOTES/COMMENTS                                                                                      
       
                                                                                                                     
     
     
       
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