Employment Application - Step I

  APPLICANT INFORMATION
Last Name
 		First Name
 		M.I
 		Date
Street Address
 		Apartment/Unit #
City
 		State
 		Zip
Phone
 		E-mail Address
Date Available
 		Social Security No.
 		Desired Salary
Position Applied for
Are you a citizen of the United States? Yes
 		No
 		  If no, are you authorized to work in the U.S.?   Yes No
Have you ever worked for this company? Yes
 		No
 		  If so, when?
Have you ever been convicted of a felony? Yes
 		No
 		  If yes, explain
 
  EDUCATION
High School
 		Address
From
 		To
 		  Did you graduate?
Yes  No
 		  Degree
  
College
 		Address
From
 		To
 		  Did you graduate?
Yes  No
 		  Degree
 
Other
 		Address
From
 		To
 		  Did you graduate?
Yes  No
 		  Degree
  
 
  REFERENCES
Please list three professional references.
 
Full Name
 		Relationship
Company
 		Phone #
Address
Full Name
 		Relationship
Company
 		Phone #
Address
Full Name
 		Relationship
Company
 		Phone #
Address





Office Hours (Mtn Standard Time):
Mon-Sat 7:00 am to 6:30 pm, Sun 10:00 am to 6:30 pm
Winter Hours: Mon-Fri 8:00 am to 5:00 pm

After hours: please call 307-765-2080 to leave a message. We will get back to you.
 
Office Phone: 307-765-2080 Fax: 307-765-2681
Toll-Free 1-800-354-8637
On-call staff person answers toll-free line after hours.

P.O. Box 206, Shell, WY 82441 

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