Applicant's Full Legal Name

Phone                                                                                   E-mail

Street Address City, State, Postal Code -- Country if outside USA

Position applied for                                                      Date you can start

Do you have the legal right to work in the US?                    Are you of legal age to work?   ---Select--- Yes No                                                                             ---Select--- Yes No

How did you learn of this opening? --SELECT ONE--- Newspaper Ad Monster.com Internet Search Employment Agency Reference   Are you currently employed?   --SELECT ONE-- YES Full Time YES Part Time NO

Would you accept full time work?                                      Would you accept part time work? --SELECT-- Yes No                                                                          --SELECT-- Yes No

Are you willing to work overtime as required?                                Minimum Compensation Requirements --SELECT-- Yes No

Do you have a physical or medical condition that would limit your capacity for this job? --SELECT-- Yes No If yes, what can be done to accommodate your limitation?

Have you ever been convicted of a felony? --SELECT-- Yes No    (Conviction will not necessarily disqualify an applicant for employment)

If yes describe conditions

EDUCATIONAL BACKGROUND

Mark highest grades completed in each category   ---SELECT ONE--- 8th 9th 10th 11th High School Graduate College  --SELECT ONE--- None 1 Year 2 Years 3 Years More the 3 Years College Graduate Graduate --SELECT ONE--- None 1 Year 2 Years More than 2 years Master's Degree Other Post Grad Degree

Post high school education Name                                                                                                                Location                             Year

Degrees or Diplomas --- Show Degree earned (e.g. BA, BS, etc.), major and minor (if any)

Additional post high school education Name       Location  Year

Degrees or Diplomas --- Show Degree earned (e.g. BA, BS, etc.), major and minor (if any)

Other Certifications Year Year Year

In addition to your work history, please note any other experiences, skills, or qualifications that would be helpful in considering your application

PREVIOUS EMPLOYERS

1. Most recent Employer  Company Name                                                                                                                                   From        To             Contact Name                                                                             Position                                                  Phone                  Address  Position(s)  Duties/Responsibilities  Beginning Salary            Ending Salary                              May we contact this employer?   $            $                                        Yes No Reason for leaving ; or reason for seeking other employment, if still employed

2. Previous Employer  Company Name                                                                                                                                   From          To             Contact Name                                                                             Position                                                   Phone                  Address  Position(s)  Duties/Responsibilities  Beginning Salary            Ending Salary                              May we contact this employer?   $            $                                        Yes No Reason for leaving

3. Previous Employer  Company Name                                                                                                                                    From       To             Contact Name                                                                             Position                                                 Phone                  Address  Position(s)  Duties/Responsibilities  Beginning Salary            Ending Salary                              May we contact this employer?   $            $                                        Yes No Reason for leaving

4. Previous Employer  Company Name                                                                                                                                    From       To             Contact Name                                                                             Position                                                 Phone                  Address  Position(s)  Duties/Responsibilities  Beginning Salary            Ending Salary                              May we contact this employer?   $            $                                        Yes No Reason for leaving

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge.  I understand that if I am employed, false statements may result in dismissal.  I authorize FM Resource Group (FMRG) to make an investigation of any facts set forth in this application. I understand that employment at FMRG is "at will". which means that either I or FMRG can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute.  All employment is continued on that basis .  I understand that no Supervisor, Manager or Executive of the Company, other than the President has any authority to alter the foregoing. Do not submit until form is completely filled out.  If you would like a copy press the Print button on your browser before pressing ACCEPT/SUBMIT