Date of Application Date Available to Work

Position Applying For:

Last Name First Name MI

Street Address City State Zip

Home Phone Work Phone Cell Phone

Email Address

Please provide other names used on education or employment records (if any)

TMI Requires a Drug Test: For certain sensitive positions, the applicant(s) who most closely match(es) the job qualifications will be asked to take a medically superevised drug test. If the outcome of the test is positive for drugs or alcohol, the applicant will be given a reasonable opportunity to provide medical evidence to explain the outcome.

Criminal Record Clearance: IF THERE ARE NO CONVICTIONS TYPE "NONE" IN THE BOX BELOW.
[Conviction will not necessarily disquality an applicant from employment. Failure to disclose any conviction will disquality an applicant or employee from employment.] TMI employees must be cleared from criminal convicton by the California Department of Justice. Please explain ALL convictions (including nature of crime, case number, city, county, state, name of court, date of conviction.) EXCLUDE CONVICTIONS for marijuana-related offenses more than two years old; convictions that have been sealed, expunged or legally eradicated; and misdemeanor convictions for which probation was completed and the case dismissed.

Employment Record - Starting with present or most recent, list all previous employers. Include self-employment and summer and part time jobs.

May We Contact Your Present or Last Employer? YES NO

#1. Last or Present Employment: Dates Worked: From To

Company Type of Business

Street Address City State Zip

Phone Number Supervisor's Name

Total Hours Worked Per Week Base Salary Type or Classification of Job

Brief Description of Job Duties:

Reason for Leaving

#2. Previous Employment: Dates Worked: From To

Company Type of Business

Street Address City State Zip

Phone Number Supervisor's Name

Total Hours Worked Per Week Base Salary Type or Classification of Job

Brief Description of Job Duties:

Reason for Leaving

#3. Previous Employment: Dates Worked: From To

Company Type of Business

Street Address City State Zip

Phone Number Supervisor's Name

Total Hours Worked Per Week Base Salary Type or Classification of Job

Brief Description of Job Duties:

Reason for Leaving

Educational History

High School Location (City/State)

Dates Attended: From To Graduated with Diploma? YES NO

College (List All Attended)

Name Location (City/State)

Dates Attended: From To Graduated YES NO

Major Course/Subject Degree

Name Location (City/State)

Dates Attended: From To Graduated YES NO

Major Course/Subject Degree

Technical/Trade School Location (City/State)

Dates Attended: From To Completed YES NO

Major Course/Subject Certification

Other Education/Training

Name Location (City/State)

Dates Attended From To Graduated YES NO

Major Course/Subject Degree

TMI verifies all job related work experience and educational requirements including degrees, credentials and certificastions as a condiditon of employment.

Outside Activities (Exclude those iundicating race, color, religion, gender, national origin, age, disability, or any other protected status.)

Professional Memberships, Certificastes, or Licenses Held:

Past and Present Civic or Cultural Activities - Include Offices Held:

Administrative Skills (Only If Job Related):

Word Processing/Typing Speed YES NO

How Many Words Per Minute:

Years Typing Experience:

Types of machines operated:

Computer Skills YES NO

Hardware:

Software:

Years of Experience with Computers:

Other Related Skills (ie; language, certification or experience you have acquired):

U.S.. Military Record

Branch of Service:

Dates Served: From To

Present Military Affiliation: NONE RESERVE (Active) RESERVE (Inactive)

Kinds of Training and Duty while in Service:

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? YES NO
(Proof of citiinzenship or immigration status will be required upon employment.)

NOTE TO APPLICANTS: You are NOT required to answer the following question and you will not be discriminated against for answering the question.

Would you require any reasonable accommodations to perform the essential functions of the job for which you have applied? YES NO

TERMS OF APPLICATION - Please read the following statement.

I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company's service, if employed. I understand the terms of this application that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment. I understand that nothing in this application is intended to explicitly or implicitly represent that any applicant is promised any permanent employment. I understand and agree that my continued employment is strictly "at will" and that the employment relationship can be terminated upon the will of the company or myself without cause and/or for any reason.

I have read the above statement and by choosing "I Accept" means that I understand and accept the terms of this Application of Employment.

I ACCEPT I DO NOT ACCEPT