Current Address(Street)

Apt#

City

State

Zip Code

How long have you lived at this Address?

Previous Address(Street)

Apt#

State

Zip Code

How long have you lived at this Address?

Home Phone Number

Cell Phone Number

E-Mail Address

Social Security No. #

D/O/B

Driver License #

If Yes, What for and How long?

Education

High School

Name of High School, Number of years completed / Grade Pt. Average / Degree

College

Name of College, Number of years completed / Grade Pt. Average / Degree

Business School

Name of Business School, Number of years completed / Grade Pt. Average / Degree

Other Education

List Awards and Honors

If Yes, What language or languages.

MILITARY SERVICES

If Yes

Please describe some of your duties.

What specialized skills or technical skills did you learn that can be applied to this job?

EMPLOYMENT HISTORY

Please list your most current place of employment to your most previous employment.

Employer

Phone No. #

Address

City

State & Zip Code

Name of Supervisor

Dates Employed From / To

Start Date End Date

Ending Salary

You’re Job Title

Please give a brief description of your duties and responsibilities

Reason for Leaving

Employer

Phone No. #

Address

City

State & Zip Code

Name of Supervisor

Dates Employed From / To

Start Date End Date

Ending Salary

You’re Job Title

Please give a brief description of your duties and responsibilities

Reason for Leaving

Personal Reference

1st.

Name / State / Relationship or Title / Phone No.# / Years Know

2nd.

Name / State / Relationship or Title / Phone No.# / Years Know

3rd.

Name / State / Relationship or Title / Phone No.# / Years Know

If Yes

Why are you interested in working for KTCTR company?

What strengths or skills would you bring to our company?

How did you hear about our company

What is your desired salary?

If hired, when would you be available to start work?

If hired, all KTCTR employees will be subject to random drug testing.

Relationship: & Phone Number

KTC Tire Recovery Application for Employment