TELEPHONE SERVICES REPRESENTATIVE

Last Name*	First Name*	MI
Street Address*
City*	State*	Zip*
	AL AK AZ AR CA CO CT DC DE FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NA NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
Phone*	Alternate Phone	Email Address

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Person to Notify In Case of Emergency		Emergency Phone
		Alt Emergency Phone

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Location you are applying for*	Mankato Phoenix St Cloud
Type of position you would prefer*	Full-Time Part-Time
Date you are available to start (mm/dd/yyyy EX: 12/11/2010)*
Salary Requirements
Do you have reliable transportation to work?*	Yes No
Have you worked in any of the following fields:
Politics Customer Service Fund Raising Telemarketing Sales
Have you ever worked for FLS?* If Yes, when?	Yes No
Have you ever been convicted of or pled guilty to a Felony offense related to fraud, physical harm to another or any financial related convictions?	Yes No *
If yes, please explain:

Employment Experience
Please list your job history starting with your current or most recent position. Include any periods in which you were not employed and explain what you were doing during that time. Include U.S. military experience (show rank/rate at discharge), summer/part-time jobs, and cooperative education assignments.
Current Employer
Current/Previous Employer	StreetAddress	Phone
City	State	Zip
	AL AK AZ AR CA CO CT DC DE FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NA NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
Starting Pay/hr	Ending Pay/hr
Starting Position Title	Ending Position Title
Start Date (Month/Year)	End Date (Month/Year)
Supervisor Name	Supervisor Title

Type of position	Full-Time Part-Time
If part-time, approximate number of hours/week worked
May we contact your present employer?	Yes No

Reason for leaving

Describe responsibilities and/or accomplishments

Previous Employer	StreetAddress	Phone
City	State	Zip
	AL AK AZ AR CA CO CT DC DE FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NA NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
Starting Pay/hr	Ending Pay/hr
Starting Position Title	Ending Position Title
Start Date (Month/Year)	End Date (Month/Year)
Supervisor Name	Supervisor Title

Type of position	Full-Time Part-Time
If part-time, approximate number of hours/week worked
May we contact your present employer?	Yes No

Reason for leaving

Describe responsibilities and/or accomplishments

Previous Employer	StreetAddress	Phone
City	State	Zip
	AL AK AZ AR CA CO CT DC DE FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NA NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
Starting Pay/hr	Ending Pay/hr
Starting Position Title	Ending Position Title
Start Date (Month/Year)	End Date (Month/Year)
Supervisor Name	Supervisor Title

Type of position	Full-Time Part-Time
If part-time, approximate number of hours/week worked
May we contact your present employer?	Yes No

Reason for leaving

Describe responsibilities and/or accomplishments

References
List 3 people (not friends or relatives), preferably past employers or co-workers, who can tell us about your qualifications.
Past Employer/Title	Company
Home Phone	Work Phone
Past Employer/Title	Company
Home Phone	Work Phone
Co-Worker	Company
Home Phone	Work Phone
Explain why you want to work for FLS and why you would be a good candidate for this position

Education
Highest Grade Completed	High School	College
	Freshman Sophomore Junior Senior GED	Freshman Sophomore Junior Senior 4+
Technical College/ Trade School	Name
	Skill/Trade Studied	Degree/Certificate Earned
		Yes No
College	Name
	Major Studied	Degree Earned
		Yes No

How did you hear about FLS*

NewspaperWhich Newspaper  Job Service College/School Community Agency (Workforce Center, Social Services, etc. Job FairLocation  Other Referral from Employee/BusinessReferral Name

Authorization

By clicking the SUBMIT button I authorize and agree to the following items: 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 statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.