Long-Lewis Sterling Application For Employment Instructions: Please complete all questions. Include any supplemental information that you feel would be helpful in our consideration of your qualification. If you need additional space for your responses below, use the box entitled "other". Long-Lewis is an Equal Opportunity Employer. Applicant Information Date:  Name: (first, last, mi)   SSN:  Address: City:  State:  ZIP:  Home Phone:     Business Phone:  Are you over 18 years of age?: Yes   No   Do you currently have relatives working for Long-Lewis? If so, who? Have you ever been convicted of a felony? If so, when and where? Position applying for: Service Technician Body Shop Mechanic Tele-Marketer Sales Representative Desired Starting Salary:  Applying for: Full Time   Part Time      # of hours:  Date you can begin working:  What shifts are you available to work? 1st   2nd   Weekends   All Are there any other names under which your employment or educational records, references, and other information may be verified? If so, list If hired, can you furnish proof that you are either a U.S. citizen, or otherwise legally permitted to work in the United States? Yes   No   Education Your educational record will be considered only to the extent that it is relevant to the job sought. Name and Location of High School Academic Majors    GPA  Name and Location of Colleges/Trade Schools     From     To   Academic Majors      GPA    Degree      Date  Extracurricular Activities & Scholarships List those extracurricular activities and scholarships, which you believe are related to the position for which you are applying. Proficiencies If applying for a position in which computer skills or secretarial/clerical skills are relevant, please answer the following. List all makes and models of computers and operating office systems with which you have had operations experience. List all data processing, telecommunications, or office equipment on which you are proficient. List all computer languages with which you have had experience. Typing speed:  wpm United States Military Service If you obtained any experience or skills while in military service that relates to the job for which you are applying, please describe the duties that led to the experience. Employment Background Employer: Address: Name and Title of Supervisor: Your last position and duties: Your starting position and duties: Phone: Employed From (Mo/Yr): Employed To (Mo/Yr): Total Months: Starting Base Pay: Ending Base Pay: Reason For Leaving: Other compensation (give detail on commissions, incentives, bonuses, etc.): Employer: Address: Name and Title of Supervisor: Your last position and duties: Your starting position and duties: Phone: Employed From (Mo/Yr): Employed To (Mo/Yr): Total Months: Starting Base Pay: Ending Base Pay: Reason For Leaving: Other compensation (give detail on commissions, incentives, bonuses, etc.): Employer: Address: Name and Title of Supervisor: Your last position and duties: Your starting position and duties: Phone: Employed From (Mo/Yr): Employed To (Mo/Yr): Total Months: Starting Base Pay: Ending Base Pay: Reason For Leaving: Other compensation (give detail on commissions, incentives, bonuses, etc.):

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