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* Please note that this is only a portion of the full application. MEC highly recommends that you come to the MEC offices and fill out the application in its entirety (please bring your resume with you). You may be asked to do just that upon review of this brief.

 
: : :

Name (Last, First, Middle):

Home address:

City:

State:

Zip:

Phone:

Email:

How did you hear about MEC?:

Position you are applying for:

Date you can start:

Desired salary:

Are you a US Citizen? Yes No

If not a U.S. Citizen, give Visa No. and Expiration Date:

Have you been convicted of a misdemeanor or felony which was not expunged? Yes No

EDUCATION RECORD

High School (Name, City, State):

Graduation Date:

Business or Technical School (Name, City, State):

Dates Attended:

Degree Earned:

Undergraduate College (Name, City, State):

Dates Attended:

Degree, Major:

Graduate School (Name, City, State):

Dates Attended:

Degree, Subject:

WORK HISTORY (GIVE INFORMATION ABOUT YOUR LAST 3 JOBS, STARTING WITH THE MOST RECENT)

1-Employer:

Dates Employed:

Address:

City:

State:

Zip:

Phone:

Ending Salary:

Title/Duties:

Manager's Name and Title:

Reason for Leaving:

2-Employer:

Dates Employed:

Address:

City:

State:

Zip:

Phone:

Ending Salary:

Title/Duties:

Manager's Name and Title:

Reason for Leaving:

3-Employer:

Dates Employed:

Address:

City:

State:

Zip:

Phone:

Ending Salary:

Title/Duties:

Manager's Name and Title:

Reason for Leaving:

BUSINESS REFERENCES (IF APPLYING FOR YOUR FIRST JOB, YOU MAY USE ACADEMIC REFERENCES)

1-Name:

Work Phone:

Home Phone:

Address:

City:

State:

Zip:

Relationship to You:

2-Name:

Work Phone:

Home Phone:

Address:

City:

State:

Zip:

Relationship to You:

3-Name:

Work Phone:

Home Phone:

Address:

City:

State:

Zip:

Relationship to You:

Any other information you’d like to add:

I certify that the information I have put on this form is accurate and true.


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