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Profile Information
*Last Name: *First, MI:
*Address: *Home Ph:
   Work Ph:
*City:  Mobile Ph:
*State:  Msg Ph:
*Zip Code:  Pager:
Email: Emergency Ph:
*How did you hear about us?
If you have been referred by an employee or friend, please provide his/her name and/or email:
First NameLast NameEmail

Education
  Name of School
City and State
Graduated? Yes or No Degree Earned OR Credit Hours Earned
High School
Junior College
University
Graduate School



Work Information
Are you currently employed? Yes No
May we call you at work? Yes No
Desired Salary:



Work History
Please list your last five employers (most current first).
Company 1 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 
Company 2 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 
Company 3 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 
Company 4 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 
Company 5 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 

References
Please list references other than stated above that we have permission to contact.
Name Title Telephone Relationship


EEO Information
To assist in gathering statistical information required to demonstrate TAD PGS, Inc.'s compliance with Equal Employment Opportunity laws, please voluntarily complete this form. Neither the information contained in the form nor your decision not to fill out this form will be considered in arriving at a decision regarding your employment. This information will be filed separately from your employment application.

(I) Please check the race or ethnic group to which you belong:

(1) American Indian or Alaska Native (Not Hispanic or Latino)
    A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
 
(2) Asian (Not Hispanic or Latino)
    A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
 
(3) Black or African American (Not Hispanic or Latino)
    A person having origins in any of the black racial groups of Africa.
 
(4) Hispanic or Latino
    A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
 
(5) I choose not to self identify
 
(6) Native Hawaiian or Other Pacific Islander (Not Hispanic/Latino)
    A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
 
(7) Two or More Races (Not Hispanic or Latino)
    All persons who identify with more than one of the above five races.
 
(8) White (Not Hispanic or Latino)
    A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
 

(II) Please indicate if you belong to either of the two groups listed below:

Vietnam Veteran - (a) A person who served more than 180 days of active military, navy, or air service, any part of which was during the period of August 5, 1964 through May 7, 1975, and who (1) was discharged or released with other than a dishonorable discharge, or (2) was discharged or released from active duty because of a service-connected disability if any part of his or her active duty was between August 5, 1964 and May 7, 1975. (b) A person who served more than 180 days of active military, navy, or air service, who served within the Republic of Vietnam, any part of which was during the period of February 28, 1961 through May 7, 1975, and who (1) was discharged or released with other than a dishonorable discharge, or (2) was discharged or released from active duty because of a service- connected disability if any part of his or her active duty was between February 28, 1961 and May 7, 1975.
 
Other Protected Veteran - A veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.
 
Special Disabled Veteran - A veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Veterans Administration for a disability (1) rated at 30 percent or more, or (2) rated at 10 to 20 percent in the case of a veteran who has been determined under section 3106 of Title 38, U.S.C., to have a serious employment handicap or (B) a person who was discharged or released from active duty because of a service-connected disability.
 
Recently Separated Veteran - A veteran who served on active duty in the US military, ground, naval, or air service during a one-year period beginning on the date of a veterans' discharge or release from active duty.
  If recently seperated vet, please provide discharge date:  
 




 
*Are you working now?:
  No   Yes  
 
*Are you open to contract work?:
  Yes   No  
 
*How soon can you start if offered a position?:
   
 
*If necessary, are you willing to relocate at your own expense for the right opportunity?:
  Yes   No  


Login Information
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