A. Domco Inc
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A. Domco Decorating Inc. - Application For Employment

PERSONAL INFORMATION:
First Name:  Middle Initial:     Last Name:
Social Security #:
Address:
City: State: Zip Code:
Home Phone #:
Marital Status:
Age: Birth Date:
Valid License #: State:    Violations:
Position Desired: Minimum Starting Salary:
Date You Can Start:
Are You Employed Now?: Yes No If So, May We Inquire: Yes No
Have You Ever Worked
For Domco Before: 		Yes No If Yes, When?
GENERAL INFORMATION:
Do You Plaster: Yes No Can You Hang Paper: Yes No
Can You Dry Wall: Yes No Can You Paint: Yes No
Spray Using Airless: Yes No Prep For Paint Or Paper: Yes No
Describe Any Talents You Have Other Than In The Painting Field Which We May Call Upon You To Preform, If We See The Need:
FORMER EMPLOYERS:
Start Date: / Name: Salary:
End Date: / Address: Position:
Reason For Leaving:
Start Date: / Name: Salary:
End Date: / Address: Position:
Reason For Leaving:
Start Date: / Name: Salary:
End Date: / Address: Position:
Reason For Leaving:
PHYSICAL RECORD:
Do You Have Any Physical Limitations That Preclude You From Preforming Work For Which You Are Being Considered?:
Yes No
If Yes, Please Describe:
In Case Of Emergency, Please Notify The Person Below:
Name   Phone #

I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE, AND UNDERSTAND THAT IF EMPLOYED, FALSIFIED INFORMATION ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORIZE THE INVESTIGATION OF ALL STATEMENTS CONTAINTED HEREIN, AND THE REFERENCES LISTED ABOVE...

I UNDERSTAND AND AGREE THAT IF, HIRED, MY EMPLOYMENT....
I have read the above statements and understand.
Name: February 8, 2012

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510 Doe Run Road East Fallowfield, PA 19320-4244
Telephone (610)344-7000