Name (First, Middle, Last)

Email Address

Street Address

City, State, Zip

If looking to relocate from out of the area, please indicated timeline and any important information

Home Phone (something with a voice mail box)

Do you have a Social Security Number? (YES/NO) Do you have a Social Security Number? (YES/NO) YES NO

Are you eligible to work in the United States? (YES/NO) Are you eligible to work in the United States? (YES/NO) YES NO

Are you 18 years of age or older? (YES/NO) Are you 18 years of age or older? (YES/NO) YES NO

If you are under 18, what is your current age?

Do you have a valid driver's license? (required for field positions) Do you have a valid driver's license? (required for field positions) YES NO

Highest Level of Education Highest Level of EducationHigh SchoolCollegeG.E.D.

Name of School

City and State of School

Did you graduate? Did you graduate? YES NO

If you answered YES give date of graduation:

If you answered NO to the above question, give the number of years left to graduate:

If College, What Degree Was Received?

WORK EXPERIENCE: Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same company, detail each position seperately. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Please note: JCWIFI and Computer Dynamics reserves the right to contact all current and former employers for reference information.

Job 1: Organization Name and Address

Job 1: Dates Employed (most recent position): From/To

Job 1: Full Time/Part Time? Job 1: Full Time/Part Time? FULL-TIME PART-TIME

Job 1: Position

Job 2: Organization Name and Address

Job 2: Dates Employed (most recent position): From/To

Job 2: Full Time/Part Time? Job 2: Full Time/Part Time? FULL-TIME PART-TIME

Job 2: Position

Please fill in the appropriate section for anything listed below that may not already be included in your above work history or attached resume.

Skills: Please list any skills relevant to this position.

Carpentry – Working with hands and tools. Examples might be replacing roof, building addition, building deck

Electrical – Changing outlets in a house, running wire from breaker box to outlet

Low voltage – Experience with ethernet wire

Dealing with people – Customer service skills

Fear of heights – Tallest thing climbed

Relevant Skills – Store

Other things you would like us to know