Job applied for: ___________________________________________

Today's Date: _______________________________

Are you seeking: ___ Full-time ___ Part-time ___ Temporary employment?

When could you start work? ____________________________

  Are you currently employed? ___ Yes ___ No   

     ___  Full-Time (OR) ___ Part-Time

Salary Required $_________________________

Do you intend to resign said employment if hired by Osborne & Osborne L.L.C.?
___ Yes ___ No

LAST NAME                                FIRST NAME                       MIDDLE INITIAL    

_____________________________________________________________________

TELEPHONE NUMBER: (       )______________

PRESENT STREET ADDRESS:

_____________________________________________________

CITY, STATE: ____________________________________

ZIP CODE: ______________________

Social Security No. ________-________-________

If hired, can you furnish proof you are eligible to work in the U.S.? ___ Yes ___ No

Have you ever applied with Osborne & Osborne L.L.C. before? ___Yes ___No

If yes, when? ____________________________________

Were you ever employed by Osborne & Osborne L.L.C.? ___ Yes ___ No

If yes, when? _____________________

Have you ever been convicted of a crime (except a minor traffic violation)? ___ Yes ___ No

If "Yes," give details:
 (NOTE: A "Yes" answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying will also be considered.)
 
 
 
 
 
 Do you have a valid driver's license? ___ Yes ___ No

Driver's License Number ____________________

Class of License __________

Have you had your driver's license suspended or revoked in the last 3 years? ____ Yes ____ No

If yes, give details:
 
 
 
 
  Are you licensed/certified? ___ Yes ___ No

Years experienced in trade: ________

LIST NAME AND ADDRESS OF SCHOOLS:

  Years Completed _______ Degree Certificate _______

  Subjects Studied: _______________________________________________

High School or GED: ______________________________________________

College or University: ______________________________________________

Vocational or Technical: ____________________________________________

What skills or additional training do you have that are related to the job for which you are applying?

_________________________________________________________

What machines or equipment can you operate that are related to the job for which you are applying?

_________________________________________________________

PREVIOUS EMPLOYMENT:

 List names of employers with present or last employer listed first.
(Please include month and year.)

Name of employer__________________________________________________

Address___________________________________________________________

City, State, Zip__________________________________________________

Supervisor                                                                               Telephone Number

 _____________________________________________________________________


Date of Employment: From _________________ To ___________________

Start pay $ _______________________ Final pay $ ___________________

Reason for leaving:

__________________________________________________________________



Name of employer__________________________________________________

Address___________________________________________________________

City, State, Zip__________________________________________________

Supervisor                                                                               Telephone Number

 _____________________________________________________________________


Date of Employment: From _________________ To ___________________

Start pay $ _______________________ Final pay $ ___________________

Reason for leaving:

__________________________________________________________________



Name of employer__________________________________________________

Address___________________________________________________________

City, State, Zip__________________________________________________

Supervisor                                                                               Telephone Number

 _____________________________________________________________________


Date of Employment: From _________________ To ___________________

Start pay $ _______________________ Final pay $ ___________________

Reason for leaving:

__________________________________________________________________



Name of employer__________________________________________________

Address___________________________________________________________

City, State, Zip__________________________________________________

Supervisor                                                                               Telephone Number

 _____________________________________________________________________


Date of Employment: From _________________ To ___________________

Start pay $ _______________________ Final pay $ ___________________

Reason for leaving:

__________________________________________________________________



Name of employer__________________________________________________

Address___________________________________________________________

City, State, Zip__________________________________________________

Supervisor                                                                               Telephone Number

 _____________________________________________________________________


Date of Employment: From _________________ To ___________________

Start pay $ _______________________ Final pay $ ___________________

Reason for leaving:

__________________________________________________________________



PERSONAL REFERENCES:

Name: ____________________________________________________________

Address (Including City, State & Zip):

_________________________________________________________________

Phone: ____________________________________


Name: ____________________________________________________________

Address (Including City, State & Zip):

_________________________________________________________________

Phone: ____________________________________


Name: ____________________________________________________________

Address (Including City, State & Zip):

_________________________________________________________________

Phone: ____________________________________


By signing this application, I hereby certify that all of the above information is true and correct. If upon verification, Osborne & Osborne L.L.C. are informed of any discrepancies, they have the right to decline employment. We do not discriminate on the basis of race, color, religion, national origin, sex, age or disability or any other factor protected by law.

* Any offer of employment is contingent upon a negative result of a Pre-Employment drug screening examination. I hereby consent to a pre-and/or post-employment drug screen as a condition of my employment, if hired.

Signature of Applicant: ____________________________________________

Date: ___________________________________________________