Lighting Fixtures - Hortons Home Lighting

Personal Information
Name:
Present Address:
Address 1:
Address 2:
City:
State:
Zip Code:
Permanent Address:
Address 1:
Address 2:
City:
State:
Zip Code:
Primary Phone:
Second Phone:
eMail Address:
Referral:
Employment Desired
Position:
Salary:
Start Date: Month, Date, Year

Select Box if the answer is YES
Are you employed now?
May we contact your current employer?
US Citizen?
Have you applied to Hortons before?
If Yes, When & Where:
Education History
High School
Name & Location	Years Attended

Did You Graduate	Subjects Studied

College
Name & Location	Years Attended

Did You Graduate	Subjects Studied

Other Education
Name & Location	Years Attended

Did You Graduate	Subjects Studied

General Information
Special Study Research Work
Special Training
Special Skills
Armed Forces Services	Rank

Former Employers (Most recent first)
Employer 1
From	To

Employer	Position

Salary	Reason for Leaving

Employer 2
From	To

Employer	Position

Salary	Reason for Leaving

Employer 3
From	To

Employer	Position

Salary	Reason for Leaving

Employer 4
From	To

Employer	Position

Salary	Reason for Leaving

References (give below the names of three persons not related to you, ehom you known at least one year)
Reference 1	Address

Business	Yrs Known

Reference 2	Address

Business	Yrs Known

Reference 3	Address

Business	Yrs Known

Authorization
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statemnts caontained herein and referenced and employers listed above to give you any and all information concerning my previous employment and any pertinent information thay may have, personal or otherwise, and release the company form all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in any manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.
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