Application Form for Employment

[uacf7_step_start step-1 "Personal Information"]
[uacf7-row]
[uacf7-col col:6] Name (First, Middle, Last): [/uacf7-col]
[uacf7-col col:3] Date: [/uacf7-col]
[uacf7-col col:3] Date of Birth: [/uacf7-col]
[/uacf7-row]

[uacf7-row]
[uacf7-col col:4] Social Security Number: [/uacf7-col]
[uacf7-col col:4] Email: [/uacf7-col]
[uacf7-col col:4] Home Phone: [/uacf7-col]
[/uacf7-row]

[uacf7-row]
[uacf7-col col:6] Home Address: [/uacf7-col]
[uacf7-col col:3] City: [/uacf7-col]
[uacf7-col col:3] Zip: [/uacf7-col]
[/uacf7-row]

[uacf7-row]
[uacf7-col col:4] State: [/uacf7-col]
[uacf7-col col:4] Cell Phone: [/uacf7-col]
[uacf7-col col:4] Work Phone: [/uacf7-col]
[/uacf7-row]

[uacf7_step_end]
[uacf7_step_start step-2 "Position Details"]

[uacf7-row]
[uacf7-col col:6] Job Title: [/uacf7-col]
[uacf7-col col:3] Salary Requirement: [/uacf7-col]
[uacf7-col col:3] Start Date: [/uacf7-col]
[/uacf7-row]

[uacf7_step_end]
[uacf7_step_start step-3 "Education Details"]

[uacf7-row]
[uacf7-col col:6] High School Name: [/uacf7-col]
[uacf7-col col:3] Graduation Date: [/uacf7-col]
[uacf7-col col:3] Degree Earned: [/uacf7-col]
[/uacf7-row]

[uacf7-row]
[uacf7-col col:6] College Name: [/uacf7-col]
[uacf7-col col:3] From: [/uacf7-col]
[uacf7-col col:3] To: [/uacf7-col]
[/uacf7-row]

[uacf7_step_end]
[uacf7_step_start step-4 "Work History"]

Job 1

[uacf7-row]
[uacf7-col col:6] Employer Name: [/uacf7-col]
[uacf7-col col:3] From: [/uacf7-col]
[uacf7-col col:3] To: [/uacf7-col]
[/uacf7-row]

[uacf7-row]
[uacf7-col col:6] Title: [/uacf7-col]
[uacf7-col col:6] Duties: [/uacf7-col]
[/uacf7-row]

Job 2

[uacf7-row]
[uacf7-col col:6] Employer Name: [/uacf7-col]
[uacf7-col col:3] From: [/uacf7-col]
[uacf7-col col:3] To: [/uacf7-col]
[/uacf7-row]

Job 3

[uacf7-row]
[uacf7-col col:6] Employer Name: [/uacf7-col]
[uacf7-col col:3] From: [/uacf7-col]
[uacf7-col col:3] To: [/uacf7-col]
[/uacf7-row]

[uacf7_step_end]
[uacf7_step_start step-5 "References"]

Reference 1

[uacf7-row]
[uacf7-col col:6] Name: [/uacf7-col]
[uacf7-col col:3] Work Phone: [/uacf7-col]
[uacf7-col col:3] Home Phone: [/uacf7-col]
[/uacf7-row]

Reference 2

[uacf7-row]
[uacf7-col col:6] Name: [/uacf7-col]
[uacf7-col col:3] Work Phone: [/uacf7-col]
[uacf7-col col:3] Home Phone: [/uacf7-col]
[/uacf7-row]

Reference 3

[uacf7-row]
[uacf7-col col:6] Name: [/uacf7-col]
[uacf7-col col:3] Work Phone: [/uacf7-col]
[uacf7-col col:3] Home Phone: [/uacf7-col]
[/uacf7-row]

[uacf7_step_end]
[uacf7_step_start step-6 "Authorization & Signature"]

[uacf7-row]
[uacf7-col col:12]
I understand that any information and documents provided to PITC for the application process will be
discarded unless the applicant is employed at PITC. School is not responsible for keeping the
docuements I have provided to the school. The applicant allows PITC to contact the personnel listed in
this application as referrals.
Authorization to check the criminal history background:
[/uacf7-col]

[/uacf7-row]
[uacf7-row]
[uacf7-col col:6] Signature: [/uacf7-col]
[uacf7-col col:6] Date: [/uacf7-col]
[/uacf7-row]

[uacf7_step_end]