TMA,Inc

Turrow/McParlane Associates, Inc. 1633 Erringer Suite 208, Simi Valley, CA 93065 805.955.9500

APPLICATION FOR EMPLOYMENT

POSITION(S) APPLIED FOR _____________________________________________ DATE OF APPLICATION ____/____/__________

NAME: (Last, First, Middle)_______________________________________________________________________________________________

ADDRESS:____________________________________________________________________________________________

TELEPHONE: (_____) _______-____________________________ SOCIAL SECURITY NUMBER: ______-______-_______

Date of Birth: Month_____ Day_____ Year_____

If you are under 18, can you furnish a work permit? . . . . . . . . . . . . . . . . [___] YES [___] NO

Have you ever been employed here before? .. . . . . . . . . . . . . . . . . . . . . [___] YES [___] NO

Are you legally eligible to work in this country? . . . . . . . . . . . . . . . . . [___] YES [___] NO

(Proof of identify and legal right to work will be required upon employment.)

Date available for work: _________________________________________________________________________________

Type of employment desired: [____] Full-Time [____] Part-Time [____] Temporary

Have you been convicted of a felony in the last seven (7) years? [____] YES [____] NO

If yes, please explain: ___________________________________________________________________________________

____________________________________________________________________________________________________

(Conviction does not automatically bar you from employment.)

Driver’s license number (if driving required by job): _____________________________ State: __________________________

EDUCATIONAL BACKGROUND

NAME AND LOCATION	YEARS COMPLETED	DID YOU GRADUATE ?		COURSE OF STUDY
HIGH SCHOOL
COLLEGE		MAJOR	DEGREE
OTHER

SKILLS AND QUALIFICATIONS (Summarize special skills and qualifications acquired from employment or other experience that may qualify you for work with our Company.)

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

FORMER EMPLOYERS (List below last three employers starting with the MOST RECENT one first)

NAME OF PRESENT OR LAST EMPLOYER
ADDRESS	CITY	STATE	ZIP
STARTING DATE	LEAVING DATE		JOB TITLE
WEEKLY STARTING SALARY	WEEKLY FINAL SALARY	MAY WE CONTACT YOUR SUPERVISOR? YES ___ NO ___
NAME OF SUPERVISOR	TITLE		PHONE
DESCRIPTION OF WORK
REASON FOR LEAVING

NAME OF PRESENT OR LAST EMPLOYER
ADDRESS	CITY	STATE	ZIP
STARTING DATE	LEAVING DATE		JOB TITLE
WEEKLY STARTING SALARY	WEEKLY FINAL SALARY	MAY WE CONTACT YOUR SUPERVISOR? YES ___ NO ___
NAME OF SUPERVISOR	TITLE		PHONE
DESCRIPTION OF WORK
REASON FOR LEAVING

NAME OF PRESENT OR LAST EMPLOYER
ADDRESS	CITY	STATE	ZIP
STARTING DATE	LEAVING DATE		JOB TITLE
WEEKLY STARTING SALARY	WEEKLY FINAL SALARY	MAY WE CONTACT YOUR SUPERVISOR? YES ___ NO ___
NAME OF SUPERVISOR	TITLE		PHONE
DESCRIPTION OF WORK
REASON FOR LEAVING

Have you ever been discharged or asked to resign from any position? [____] YES [____] NO If yes, please explain:

____________________________________________________________________________________________________

PROFESSIONAL REFERENCES

NAME	TELEPHONE	YEARS KNOWN
	(____) - ______-__________
	(____) - ______-__________
	(____) - ______-__________

PLEASE READ CAREFULLY BEFORE SIGNING:

I understand and agree that any misrepresentation by me in this application will be sufficient reason to cancel this application and/or terminate my employment from the employer’s service if I have been employed. Furthermore, I understand and agree that if I am employed, I shall be employed on an at-will basis, which means my employment can be terminated and the terms and conditions of my employment changed at anytime for any reason without notice.

I understand that my employment with the Company is not for a specified period and can be terminated either by me or by the company at any time with or without cause or advance notice. I also understand that during my employment with the Company, I may either be promoted or demoted and my pay adjusted as the Company, in its sole discretion, determines. I understand that, although other terms and conditions of my employment may change from time to time at the company’s sole discretion, this employment at-will policy shall not be modified by any statements contained in this or any other company document provided to me in connection with my employment. Nothing contained in this application or in other company documents shall require the company to have cause to terminate my employment, or to discipline or demote me, or otherwise restrict the company’s right to dismiss or demote me at any time for any reason. I further understand that no person other than the president of the company has the authority to enter into an agreement for employment for a specified term or to make any agreement contrary to the at-will relationship the Company maintains with each of its employees and any contrary agreement must be in writing and signed by the president.

I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release the employer and its representatives from liability for seeking such information and all other persons, corporations or organizations for furnishing such information.

Signature of Applicant: __________________________________________________ Date _______/_______/______