GAP PARTNERS, INC.

Personal Information:

Last Name*  First Name* Middle Initial 
Street Address*  City* 
County  State*  Zip Code* 
Home Phone*  Other Phone  
E-mail Address* 
What Type Of  Work Are You Looking For? 
  *Denotes required fields

Availability:

Are You Currently Employed?  Yes No 
First Date Available   Minimum Salary Expectations?  Total Weekly Hours Preferred 

General Information:

How Did You Hear About Us?



Do You Know Anyone Currently Working For The Company? Yes No
Who? 

Can You, After Employment, Submit Verification Of Your Legal Right To Work In The United States?
Yes No

Have You Ever Been Convicted Of a Crime? Yes No
(Conviction Will Not Necessarily Exclude You from Consideration) If Yes, Please Explain Below.
Explanation:

Employment History:  PLEASE LIST MOST RECENT EMPLOYER OR PRESENT EMPLOYER FIRST

Employer's Name. Phone Number.
Address, City, State, Zip. Job Title.
Did You Work Part-Time (Less Than 32 Hours Weekly)? Yes No
Employment FromTo         Salary Start End 
Supervisor's Name. Reason For Leaving.
Type of Business Approximately How Many Employees?
Job Duties.

Employer's Name. Phone Number.
Address, City, State, Zip. Job Title.
Did You Work Part-Time (Less Than 32 Hours Weekly)? Yes No
Employment FromTo      Salary Start End 
Supervisor's Name. Reason For Leaving.
Type of Business Approximately How Many Employees?
Job Duties.

Employer's Name. Phone Number.
Address, City, State, Zip. Job Title.
Did You Work Part-Time (Less Than 32 Hours Weekly)? Yes No
Employment FromTo         Salary Start End 
Supervisor's Name. Reason For Leaving.
Type of Business Approximately How Many Employees?
Job Duties.

Employer's Name. Phone Number.
Address, City, State, Zip. Job Title.
Did You Work Part-Time (Less Than 32 Hours Weekly)? Yes No
Employment FromTo         Salary Start End 
Supervisor's Name. Reason For Leaving.
Type of Business Approximately How Many Employees?
Job Duties.

References: PLEASE LIST REFERENCES WHO ARE FAMILIAR WITH YOUR WORK.

Name Address Phone  Relationship
Name Address Phone  Relationship
Name Address Phone  Relationship
Name Address Phone  Relationship

 Certification and Authorization

I, THE APPLICANT, DO CERTIFY THAT BY MY SUBMISSION OF THIS FORM THAT THE FACTS CONTAINED IN THIS
APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT, 
IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION OR DURING A PRE-EMPLOYMENT INTERVIEW 
INCLUDING A FAILURE TO DISCLOSE REQUESTED INFORMATION, SHALL BE GROUNDS FOR DISMISSAL.

I HEREBY AUTHORIZE GAP PARTNERS, INC. TO INVESTIGATE ALL STATEMENTS CONTAINED WITHIN THIS APPLICATION AS MAY BE NECESSARY IN REACHING AN EMPLOYMENT DECISION, INCLUDING:

EMPLOYMENT HISTORY
EDUCATION
REFERENCES
CREDIT HISTORY
CRIMINAL HISTORY
                                                                             MOTOR VEHICLE RECORD (IF PERTINENT TO THE POSITION APPLIED FOR)

A BACKGROUND CHECK CAN BE CONDUCTED TO VERIFY THAT THE ACCURACY OF THE INFORMATION SUBMITTED 
AND BY THE  SUBMISSION OF THIS FORM I RELEASE GAP PARTNERS, INC. FROM ALL LIABILITY FOR ANY DAMAGE OR LOSS THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.

I AUTHORIZE AND UNDERSTAND THAT A PRE-EMPLOYMENT PHYSICAL AND DRUG SCREEN ARE REQUIRED PRIOR 
TO STARTING THE ASSIGNED POSITION, SHOULD I BE CHOSEN.

I UNDERSTAND THAT THIS FORM IS NOT AN OFFER OF EMPLOYMENT OR AN EMPLOYMENT CONTRACT, AND NO
EMPLOYMENT CONTRACT, EITHER WRITTEN OR ORAL, WILL BE OFFERED IF I AM HIRED BY GAP PARTNERS, INC.  I ALSO UNDERSTAND THAT IF I AM HIRED, MY EMPLOYMENT IS AT WILL, AND I CAN BE TERMINATED WITH OR 
WITHOUT CAUSE OR NOTICE.

 ** ALL APPLICATIONS WILL BE KEPT ON FILE FOR 6 MONTHS.