Address: 705 E. Bidwell Street, Ste 2-299, Folsom, CA, 95630, US
Telephone: 916-985-7665

14%

APPLICANT INFORMATION
Your Name*
First M.I. Last
Address*
Street Address Apartment/Unit # City State ZIP Code
Phone*
Email Address*
Date Available*
Date Format: MM slash DD slash YYYY
Social Security No. (last 4 digits)*
Desired Salary*
How Did You Hear About This Job?*
Are you a US Citizen?*
- Yes
- No
If no, are you authorized to work in the U.S.?
- Yes
- No
Have you ever worked for this company?*
- Yes
- No
If so, when?
Have you ever been convicted of a felony?*
- Yes
- No
(yes, we have less than five employees)
If yes, explain.

TELL US ABOUT YOURSELF
Why do you think you would be a good fit for this job and tell us why we should consider you?*

DISCLAIMER AND VERIFICATION
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
I authorize Mike The Poolman to access or obtain previous employment records if necessary.*
- Authorize
I confirm that all of the information that I have presented in this application is truthful and correct*
- Confirm
Date
Date Format: MM slash DD slash YYYY

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