APPLICATION FOR EMPLOYMENT
PREMIER LAB SUPPLY, INC. "An Equal Employment Opportunity Employer M/F/D/V”
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Email *
First and Last Name *
What job are you applying for *
Required
Present address *
Best phone # to reach you *
Best e-mail to reach you *
Are you a US citizen? *
Required
If not a U.S citizen, are you lawfully authorized to work in the U.S.? *
Required
Have you been convicted of a felony or drug-related offense within the last 7 years? *
Required
Starting salary per hour required: *
List below your skills and abilities (Knowledge of certain computer software, equipment, etc.) that are applicable to the position you are applying for. *
List below present and past employment, beginning with your most recent, including military service.
Company 1 Name and Address: *
Your Title 1: *
Your Duties 1: *
Starting Salary 1: *
Ending Salary 1: *
Company 2 Name and Address:
Your Title 2:
Your Duties 2:
Starting Salary 2:
Company 3 Name and Address:
Your Title 3:
Your Duties 3:
Starting Salary 3:
Ending Salary 3:
List the highest level of your education *
Please list your personal references:
1. Name / Title
1. Address
1. Phone #
2. Name / Title
2. Address
2. Phone #
3. Name / Title
3. Address
3. Phone #
Your remarks
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