PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

Date ________________

Name _____________________________________________________________________________
Last First Middle Maiden

Present address _____________________________________________________________________
Number Street City State Zip How long _________

Social Security No. _______ – _____ – _______

Telephone (        )__________________ If under 18, please list age ______

Position applied for  ________________________ Salary desired ________________________

(Be specific) Days/hours available to work
No Pref _______ Thur ________
Mon __________ Fri __________
Tue __________ Sat _________
Wed _________ Sun _________

How many hours can you work weekly? _________ Can you work nights? ___________
Employment desired _____ FULL-TIME ONLY _____ PART-TIME ONLY _____ FULL- OR PART-TIME

When available for work?______________________________________________________________

Name of school and location____________________________________________________________
(Complete mailing address)

Number of years completed_________________

Major & Degree_______________________________________________

High School_______________________________________________________________________

College___________________________________________________________________________

Bus. or Trade School________________________________________________________________

Professional School_________________________________________________________________

Have you ever been convicted of a crime? ____ No ____ Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. __________________________________________________________________________________
__________________________________________________________________________________

Do you have a driver's license? ____ Yes ____ No
What is your means of transportation to work? _______________________________________________________________

Driver’s license
number _____________________ State of issue ________

Have you had any accidents during the past three years? How many? ___________________

Have you had any moving violations during the past three years? How Many? ___________________

Office Only:
Skills ___________________________________________________________________

Please list two references other than relatives or previous employers.
Name __________________________________ Name ________________________________________
Position ___________________________________ Position ___________________________________
Company __________________________________ Company ___________________________________
Address ___________________________________ Address ____________________________________
Telephone (_____)________________________ Telephone (____)______________________

An application form sometimes makes it difficult for an individual to adequately summarize a
complete background. Use the space below to summarize any additional information necessary
to describe your full qualifications for the specific position for which you are applying.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Military
Have you ever been in the armed forces? ____ Yes ____ No
Are you now a member of the National Guard? ____ Yes ____ No
Specialty _____________________________ Date Entered __________ Discharge Date __________
Work Experience_____________________________________________________________________

Please list your work experience for the past five years beginning with your most recent job held.
If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer_______________________________________________
Address_______________________________________________________
Name of last supervisor___________________________________________
Employment dates_______________________________________________
City, State, Zip Code_____________________________________________
Phone number____________________ From/To________________________
Your last job title______________________________________________________
Reason for leaving (be specific)_______________________________________________________
List the jobs you held, duties performed, skills used or learned, advancements or promotions
while you worked at this company.____________________________________________________
_________________________________________________________________________________

Name of employer______________________________________________
Address______________________________________________________
Name of last supervisor__________________________________________
Employment dates______________________________________________
City, State, Zip Code____________________________________________
Phone number____________________ From/To____________________________
Your Last Job Title____________________________________________________
Reason for leaving (be specific)______________________________________________________
List the jobs you held, duties performed, skills used or learned, advancements or promotions
while you worked at this company.____________________________________________________
_________________________________________________________________________________

May we contact your present employers? ____ Yes ____ No
Did you complete this application yourself? ____ Yes ____ No
If not, who did?_____________________________________________________________________

Signature:_______________________________________________ Date:_______________________________

PRINT, COMPLETE, AND MAIL TO OFFICE: Turning Point Foundation PO Box 1955 Maple Grove, MN 55369