CEDAR VALLEY CORP.

Employment Application

Please fill out the entire application below to be considered for employment.
Items with a red * are required.

PERSONAL
* Position Desired:

* How did you learn about this position?

Friend

Relative

Website

Newspaper (list paper)

Employment Agency (give name)

Other (list source)


* Last Name:	* First Name:	* Middle Initial:
* Social Security Number:
Have you ever used a name other than that shown above? (Nick-name also) If so, list name and dates used: (name - 05/05/05)
Have you ever used another social security number? If so, list number and dates used: (ss# - 05/05/05)

* Address:

Address 2:

* City:

* State:

* Zip Code:

* Primary Phone:

Alternate Phone:

E-mail:


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

Are you available to work? Full Time Part Time Temporary
Are you currently employed? YES NO
May we contact your present employer? YES NO
Are you currently on "lay-off" status and subject to recall? YES NO

Have you ever been employed by us before?
YES NO

If Yes, give date

Can you travel if the job requires it?
YES NO

Out of town?
YES NO

Out of state?
YES NO

Do you have reliable transportation to get yourself to and from the job site? YES NO
Have you ever been convicted of any crime? (Conviction will not necessarily disqualify an applicant from employment.) YES NO If yes, explain
State any reason why you will, if hired, be unavailable for work for a period of time exceeding one week in the next year.