I. PERSONAL INFORMATION

Full Name: ______________________________ Date: ___________
Address: ________________________________________________
Email: __________________________________ Phone: ___________________
Social Security Number (SSN): ___________________________
Date Available: ______________ Desired Pay: $________ ☐ Hour ☐ Salary
Position Applied For: ___________________________________
Employment Desired: ☐ Full-Time ☐ Part-Time ☐ Seasonal

II. EMPLOYMENT ELIGIBILITY

Are you legally eligible to work in the U.S? ☐ Yes ☐ No
Have you worked for Alazel Limited before? ☐ Yes ☐ No
If yes, dates: ___________ to ___________
Felony conviction? ☐ Yes ☐ No
If yes, explain: _________________________________________

III. EDUCATION

High School: ____________________ City/State: _______________
From: _________ To: _________ Graduate? ☐ Yes ☐ No Diploma: _____________

College: ________________________ City/State: _______________
From: _________ To: _________ Graduate? ☐ Yes ☐ No Degree: ______________

Other Education/Certifications: ___________________________
City/State: __________ From: _______ To: _______ Certification: ____________

IV. PREVIOUS EMPLOYMENT

Employer #1: __________________ Email: __________ Phone: _________
Address: ________________________________________________
Start: $_______ ☐ Hr ☐ Salary End: $_______ ☐ Hr ☐ Salary
Job Title: __________________ Responsibilities: ________________________
From: _______ To: _______ Reason for Leaving: _________________________

Employer #2: __________________ Email: __________ Phone: _________
Address: ________________________________________________
Start: $_______ ☐ Hr ☐ Salary End: $_______ ☐ Hr ☐ Salary
Job Title: __________________ Responsibilities: ________________________
From: _______ To: _______ Reason for Leaving: _________________________

Employer #3: __________________ Email: __________ Phone: _________
Address: ________________________________________________
Start: $_______ ☐ Hr ☐ Salary End: $_______ ☐ Hr ☐ Salary
Job Title: __________________ Responsibilities: ________________________
From: _______ To: _______ Reason for Leaving: _________________________

V. PROFESSIONAL REFERENCES

Reference #1: Name: ______________ Relationship: __________
Company: __________ Title: __________ Email: _______ Phone: _________

Reference #2: Name: ______________ Relationship: __________
Company: __________ Title: __________ Email: _______ Phone: _________

Reference #3: Name: ______________ Relationship: __________
Company: __________ Title: __________ Email: _______ Phone: _________

VI. MILITARY SERVICE

Veteran? ☐ Yes ☐ No Branch: ______________ Rank: ___________
From: _______ To: _______ Discharge Type: _______________
If not honorable, explain: ________________________________

VII. BACKGROUND CHECK CONSENT

Consent to background check? ☐ Yes ☐ No

VIII. DISCLAIMER & SIGNATURE

I certify that all information provided is true and complete. Any false or misleading information may result in disqualification or termination if employed.

Signature: ___________________________ Date: ___________
Print Name: __________________________