N A M E A N D A D D R E S S. WORK TELEPHONE (Provide only one including area code): CITY STATE ZIP CODE: OTHER (include area code):

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1 KOREN WOMEN S SSOCITION EMPLOYMENT PPLICTION Please complete the application by typing or clearly printing in dark ink. Submit a separate application (photocopy TYPE or PRINT in INK acceptable) for each recruitment announcement. If your application materials do not clearly show you meet the qualifications of the job for which you are applying, your application will not be accepted JOB PPLIED FOR (Listed on the recruitment announcement): Have you ever been convicted of a felony (circle one): Yes or No What was the offense and final disposition? Military Veteran (circle one): Yes or No Years of Service: Branch: DRIVER S LICENSE NUMBER: STTE OF ISSUE: NME (LST, FIRST, M.I.): N M E N D D D R E S S HOME TELEPHONE (include area code): MILING DDRESS: WORK TELEPHONE (Provide only one including area code): CITY STTE ZIP CODE: OTHER (include area code): EMIL DDRESS: K PGER CELL PHONE MESSGE W PRESENT EMPLOYER LST EMPLOYER (Check one): May We Contact? CITY ND STTE: Yes No WORK SCHEDULE VILBILITY Check Only One: Check Only One: Date You Can Report For Work: PERMNENT (P) SESONL (S) EITHER (B) FULL TIME (F) FULL OR PRT TIME (E) JOB SHRE (J) PRT TIME (P) INTERMITTENT (I) NY (B) re you also willing to work for KW Companies in a temporary position? (Check one) YES NO re you Bilingual? (YES/NO) LNGUGE If Yes, What language could you speak/write/read? EDUCTION / TRINING HISTORY List colleges, military, trade, business or other schools attended. Do you have a high school diploma or a GED certificate? (Check one) YES NO Name and Location of School, College, or University Course of Study (List Major) Credits Earned Check One & Indicate Hours Did You Graduate? (Yes / No) Degree or Certificate Received (, B, BS, M, PhD) B C LICENSE / REGISTRTION / CERTIFICTE List any required professional license, registration, certificate, Washington Commercial Driver s License (CDL), etc. Description State Number Expiration

2 SPECILIZED SKILLS ND KNOWLEDGE List skills or knowledge that show your ability to perform the job for which you are applying (such as typing speed, computer languages, software programs, etc.). ttach additional pages as needed. REFERENCES Name Relationship ddress Phone/ B C WORK HISTORY JOB NUMBER 1 (current or most recent position) ssigning and Reviewing Work work Handling Disciplinary Problems problems FROM (MONTH - YER) TO (MONTH - YER) Rating Work Performance Responding to Grievances TOTL TIME IN CURRENT HOURS WORKED PER OR LST POSITION: CONTINUE WORK HISTORY ON NEXT PGE PGE 2

3 JOB NUMBER 2 ssigning and Reviewing Work Handling Disciplinary Problems FROM (MONTH - YER) TO (MONTH - YER) Rating Work Performance Responding to Grievances TOTL TIME IN POSITION: HOURS WORKED PER JOB NUMBER 3 TOTL TIME IN POSITION: HOURS WORKED PER CONTINUE WORK HISTORY ON NEXT PGE PGE 3

4 JOB NUMBER 4 If you Hiring checked or Recommending any of these boxes, Hiring list the number Not Responsible of employees for and ny their of bove job titles: TOTL TIME IN POSITION: HOURS WORKED PER JOB NUMBER 5 FROM (MONTH - YER) TO (MONTH - YER) Rating Rating Work Work Performance Performance Responding Responding to Grievances to Grievances TOTL TIME IN POSITION: HOURS WORKED PER CONTINUE WORK HISTORY ON NEXT PGE PGE 4

5 JOB NUMBER 6 TOTL TIME IN POSITION: HOURS WORKED PER CERTIFICTION ND SIGNTURE I understand that any verbal or written statement that is false, fraudulent or misleading that is contained in this application or attached materials, or made in the course of any related employment process, whether made by me or by others at my request, will result in rejection of my application, denial of employment, or dismissal from service if discovered after employment, and under some circumstances, may result in prosecution for a crime. I certify that all statements contained herein are true and complete whether made by me or others at my request. I understand that if hired, I must prove that I am legally authorized to work in the United States. I authorize KW to check employment references and verify education information provided on this employment application and as disclosed in the interview process. I authorize KW to check my driving record if the position for which I am applying requires driving. You may be asked to submit to a pre-employment drug test, a credit history check and/or criminal history background check as a condition of employment. I release KW and all providers of information from any liability as a result of furnishing and receiving any information related to KW s hiring process. I agree to the conditions stated in this Certification and Signature section, as indicated by my signature below. SIGNTURE (Must be signed IN INK): DTE: KEEP COPY OF YOUR PPLICTION FOR INTERVIEWS. COPIES WILL NOT BE PROVIDED.