Date: * Name: * Address: State/Province: Zip/Postal Code:     * Home Phone: Cell Phone:     Positions Applied For: Salary Desired: Quality Perforating Inc. 166 Dundaff Street Carbondale, PA USA 18407 Phone: 570-282-4344 (800-872-7373 Fax: 570-282-7921 When Available To Begin Work? Education Type of School Name of School and Complete Mailing Address No. Years Completed Major or Degree High School College Bus. or Trade School Professional School Other     Have you ever been convicted of a crime? yes  no If yes, please explain     Previous Employment (list up to 3) Previous Employment 1 Name of Employer Name of last supervisor Dates of employment   From: To: Salary   From: To: Complete Address: Phone # Last job title Reasons for leaving (be specific) List the job you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company: May we contact your employer? yes  no     Previous Employment 2 Name of Employer Name of last supervisor Dates of employment   From: To: Salary   From: To: Complete Address: Phone # Last job title Reasons for leaving (be specific) List the job you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company: May we contact your employer? yes  no     Previous Employment 3 Name of Employer Name of last supervisor Dates of employment   From: To: Salary   From: To: Complete Address: Phone # Last job title Reasons for leaving (be specific) List the job you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company: May we contact your employer? yes  no     Skills: Typing: Computer Applications (list all that apply): Other skills:     Please list 2 references other than relatives and previous employers Name    Position    Company    Telephone        Use this space to add any additional information necessary to describe you full qualifications for the position which you are applying: