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EMPLOYMENT APPLICATION

* indicates that a response is required

INTRODUCTION

EDUCATION

U.S. SERVICE EXPERIENCE

WORK HISTORY (Beginning with your current or most recent employment)

GENERAL INFORMATION

Please read the following statement carefully before submitting.

*I certify that the information provided by me in this application is true and complete to the best of my knowledge. I understand that if I am employed, any false statements, material, or omissions will lead to immediate dismissal, and I agree that the company shall not be held liable in any respect if my employment is terminated, or if I am no longer considered for employment for that reason. I understand that this Application for Employment and other Company documents are not contracts of employment.

Notice for Applicant:

This application is considered current for 90 days. If you want to be considered for employment after this time, you must complete another Application for Employment.

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Tel: 217-342-0400 • Fax: 217-342-0412 • Email: sales@peerlessofamerica.com