Personal Data Sheet
Name: 


  1. Name


  1. Street Address


  1. City


  1. State


  1. Zip code


  1. Telephone


  1. Emergency Contact Person


  1. Emergency Person's Phone Number


  1. High School Attended


  1. High School's Address


  1. Year completed high school


  1. Employer 1


  1. Employer 1's address


  1. Employer 1's telephone


  1. Job duties at employer 1's


  1. Dates of employment at employer 1's


  1. Employer 2


  1. Employer 2's address


  1. Employer's 2 telephone


  1. Job duties at employer 2's


  1. Dates of employment at employer 2's


  1. Reference 1 name


  1. Reference 1 address


  1. Reference 1 telephone


  1. Reference 2 name


  1. Reference 2 address


  1. Reference 2 telephone


  1. Reference 3 name


  1. Reference 3 address


  1. Reference 3 telephone


  1. Do you have a driver's license?


  1. Have you ever been in an automobile accident? If yes, please explain.


  1. Do you have a car or truck you could use on the job?


  1. How many days of work did you miss last year because of illness?


  1. How many days of school did you miss last year?


  1. Do you have any physical conditions that would limit your job performance? If so, please explain.


  1. Have you ever been convicted of a felony? If so, please explain.


  1. When is the earliest date you could start employment?





Jo Littleton