Note: you have 20 minutes to complete this application. To extend that time by another 20 minutes, submit your incomplete form and continue filling it out.

Online Sales Application

Instructions:

Fill in all blank spaces
Enter 'NA' if 'Not Applicable'
Do not enter 'See Resume'

General Information

Select Area:
Name:
Email:
Present Address:
City:
State:
Zip:
Business Address:
City:
State:
Zip:
Business Telephone Number:
Best Telephone Number to Reach You:

Name any friends of relatives employed here:
Were you referred by an employee of Valley Yellow Pages?	Yes No
If "Yes," referring employee's full name and title:
Have you ever been employed under a different name?	Yes No
If "Yes," list name:	(Required only for pre_employment reference check.)
Position Applied for:
Annual Earning Expected $:
Have you ever applied to or been employed by Valley Yellow Pages?	Yes No
If "Yes," which office:
When:

Education

High School:
City:
State:
Courses Majored In:
Did you Graduate?	Yes No
GPA:

College:
City:
State:
Courses Majored In:
Did you Graduate?	Yes No
GPA:

College:
City:
State:
Courses Majored In:
Did you Graduate?	Yes No
GPA:

Business or Trade School:
City:
State:
Courses Majored In:
Did you Graduate?	Yes No
GPA:

Other:
City:
State:
Courses Majored In:
Did you Graduate?	Yes No
GPA:

Jobs while in school and during summer

Name of Employer:
Your Job:
Your Salary:
How Job Obtained:
Hours Per Week:

Name of Employer:
Your Job:
Your Salary:
How Job Obtained:
Hours Per Week:

Name of Employer:
Your Job:
Your Salary:
How Job Obtained:
Hours Per Week:

Name of Employer:
Your Job:
Your Salary:
How Job Obtained:
Hours Per Week:

Extracurricular Activities

(Please omit any organizations which reflect race, color, sex, national origin, age, ancestry, marital status, sexual orientation, medical condition, mental or physical handicap, or other protected status.)
In High School:
Offices Held:

In College:
Offices Held:

What scholarships or fellowships have you received:

Work History

Company Name:
Address:
City:
State:
Zip:
Telephone Number:
Industry & Product/Services:
Time Employed	From: To:
How was the job obtained?
Nature of work at start: (include exact title)
Earnings per month at start:	$
Nature of work at leaving: (include exact title)
Earnings per month at leaving:	$
Reason for leaving:
Name of Immediate Supervisor:

Company Name:
Address:
City:
State:
Zip:
Telephone Number:
Industry & Product/Services:
Time Employed	From: To:
How was the job obtained?
Nature of work at start: (include exact title)
Earnings per month at start:	$
Nature of work at leaving: (include exact title)
Earnings per month at leaving:	$
Reason for leaving:
Name of Immediate Supervisor:

Company Name:
Address:
City:
State:
Zip:
Telephone Number:
Industry & Product/Services:
Time Employed	From: To:
How was the job obtained?
Nature of work at start: (include exact title)
Earnings per month at start:	$
Nature of work at leaving: (include exact title)
Earnings per month at leaving:	$
Reason for leaving:
Name of Immediate Supervisor:

Company Name:
Address:
City:
State:
Zip:
Telephone Number:
Industry & Product/Services:
Time Employed	From: To:
How was the job obtained?
Nature of work at start: (include exact title)
Earnings per month at start:	$
Nature of work at leaving: (include exact title)
Earnings per month at leaving:	$
Reason for leaving:
Name of Immediate Supervisor:

Company Name:
Address:
City:
State:
Zip:
Telephone Number:
Industry & Product/Services:
Time Employed	From: To:
How was the job obtained?
Nature of work at start: (include exact title)
Earnings per month at start:	$
Nature of work at leaving: (include exact title)
Earnings per month at leaving:	$
Reason for leaving:
Name of Immediate Supervisor:

Company Name:
Address:
City:
State:
Zip:
Telephone Number:
Industry & Product/Services:
Time Employed	From: To:
How was the job obtained?
Nature of work at start: (include exact title)
Earnings per month at start:	$
Nature of work at leaving: (include exact title)
Earnings per month at leaving:	$
Reason for leaving:
Name of Immediate Supervisor:

Company Name:
Address:
City:
State:
Zip:
Telephone Number:
Industry & Product/Services:
Time Employed	From: To:
How was the job obtained?
Nature of work at start: (include exact title)
Earnings per month at start:	$
Nature of work at leaving: (include exact title)
Earnings per month at leaving:	$
Reason for leaving:
Name of Immediate Supervisor:

Company Name:
Address:
City:
State:
Zip:
Telephone Number:
Industry & Product/Services:
Time Employed	From: To:
How was the job obtained?
Nature of work at start: (include exact title)
Earnings per month at start:	$
Nature of work at leaving: (include exact title)
Earnings per month at leaving:	$
Reason for leaving:
Name of Immediate Supervisor:

Miscellaneous

Please explain any gaps in employment.
What are your greatest strengths?
What are your greatest weaknesses?

Special Activities

(List past or present activities since leaving school) (Please omit any organizations which reflect race, color, sex, national origin, age, ancestry, marital status, sexual orientation, medical condition, mental or physical handicap, or other protected status.)
Business or Professional Activities
Name or Description of Organization:
When did you actively participate:	From: To:
Offices held during last five years:
Average time now given per week:
Name or Description of Organization:
When did you actively participate:	From: To:
Offices held during last five years:
Average time now given per week:

Lodges, Social Groups
Name or Description of Organization:
When did you actively participate:	From: To:
Offices held during last five years:
Average time now given per week:
Name or Description of Organization:
When did you actively participate:	From: To:
Offices held during last five years:
Average time now given per week:

Civic or Community Organizations
Name or Description of Organization:
When did you actively participate:	From: To:
Offices held during last five years:
Average time now given per week:
Name or Description of Organization:
When did you actively participate:	From: To:
Offices held during last five years:
Average time now given per week:

Other
Name or Description of Organization:
When did you actively participate:	From: To:
Offices held during last five years:
Average time now given per week:
Name or Description of Organization:
When did you actively participate:	From: To:
Offices held during last five years:
Average time now given per week:

Convictions

Have you ever been convicted of any felony or misdemeanor for which the record has not been sealed or exponged (do not include marijuana offenses more than two years old)? (Note: A conviction will not necessarily disqualify you from employment.)	Yes No
If "Yes," describe the conviction including the nature of the offense, the date of conviction, and the rehabilitive efforts taken since the conviction:

Geographical Preferences and Vehicle Information

If hired, when will you be available for work?
How much advance notice will you require?
Geographical preference:
Why?
Do you have full use of a vehicle for your work? (required for the job)	Yes No
Are there any other experiences, skills, trainings, or qualifications which you feel would especially qualify you for work with this company?
What are your plans or aims for the future?

Emergency Contact

Please identify who should be notified in case of accident or emergency:
Name:
Home Phone:
other Phone:
Address:
City:
State:
Zip:

Other

Are you able to perform the duties of the position for which you are applying, with or without reasonable accomodation, including regular attendance?	Yes No
Have you ever been discharged or forced to resign from a positions?	Yes No
If "Yes," please explain

Employment Eligibility Verification

If employed, Federal law requires that you present one or more original documents to your employer as proof of identity and employability.

Will you be able to furnish such documintation if hired?

Yes No

Affidavit

I hearby certify and declare that all statements given by me on this application form are truthful and complete statements to the best of my knowledge. I understand that any false or incomplete information contained on my application form will be cause for immediate discharge if I am subsquently employed.

If hired, in consideration of my employment, I agree to conform to Valley Yellow Pages work rules and policies, and I agree to sign an Employee Handbook acknowledgement form and other documents signed by new employees. In addition, I agree that either I or Valley Yellow Pages may terminate my employment with or without cause, and with or without prior notice at any time. Finally, I understand that no representative of Valley Yellow Pages, other than the President, has the authority to enter into any agreement (which agreement must be in writing) for employment for any specified period of time, or to otherwise alter the foregoing.

Valley Yellow Pages and I agree that any claim or dispute arising out of or relating to this application or Valley Yellow Pages' decision regarding my application for employment shall be determined by final and binding arbitration.

I hereby authorize all my former employers, educational instructions, and persons named herein as personal references to furnish any and all information they have concerning me, whether or not such information is on their records, and I release them from any and all liabilities or damage arising because of furnishing such information.

I agree with the preceeding statement Yes No