*First Name:

*Last Name:

*Address 1:

Address 2:

*City:

*State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tenessee Texas Utah Vermont Virgina Washington Wisconsin West Virginia Wyoming

*Zip:

*Home Phone:

Work Phone:

*Email:

*What is you date of birth?
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
*May we contact you at your work phone?
Yes No
*Type of work you are applying for?
Sales Service Technician Maintainenance Tech Installer Install Helper Secretary Appointment Setter Supervisor Dispatcher Marketing Any Available

*Type of work you are applying for (select all that apply)
Part Time Full Time Temporary Days Nights Weekends Seasonal Any

How did you select Autumn Air:( Please name employee, advertisement, etc.)

If you are not a US Citizen, what is your visa status?

*If you receive a conditional offer of employment, can you provide verification of your identity and legal right to work in the United States?
Yes No
Have you ever been convicted of a felony (Do not identify convictions that have been sealed, expunged, dismissed, pardoned, or otherwise eradicated)?
Yes No
If Yes, Please explain:

Do you have any physical limitations that may inhibit your ability to perform the tasks required of the position you are applying for?
Yes No
If Yes, Please explain:

*Are you Bilingual?
Yes No
If Yes, What languages do you speak?

*Do you have a clean driving record within the last 39 months?
Yes No
If No, Please explain:

Drivers License #

Drivers License State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
Education:
Elementary/Junior High School High School Vocational School College/University Graduate School