Sales Appllication

EMPLOYMENT BACKGROUND

Begin with your most recent employment.

Name of Employer:

Immediate Supervisor:

Employer Street Address:

City:

State:

Zip:

Phone:

From Date:

To Date:

Description of Job Duties or Products Sold:

Reason for leaving:

Job Number 2:

Name of Employer:

Immediate Supervisor:

Employer Street Address:

City:

State:

Zip:

Phone:

From Date:

To Date:

Description of Job Duties or Products Sold:

Reason for leaving:

Job Number 3:

Name of Employer:

Immediate Supervisor:

Employer Street Address:

City:

State:

Zip:

Phone:

From Date:

To Date:

Description of Job Duties or Products Sold:

Reason for leaving:

Job Number 4:

Name of Employer:

Immediate Supervisor:

Employer Street Address:

City:

State:

Zip:

Phone:

From Date:

To Date:

Description of Job Duties or Products Sold:

Reason for leaving:

If there have been any gaps on your employment, please explain:

Please list any awards, achievements, accomplishments, special skills, experience and/or training that would enhance your ability to perform the position applied for:

EDUCATION BACKGROUND

High/Prep School:

Name of School:

City:

State:

Zip:

Did You Graduate?

Yes

If Applicable, Year of Anticipated Graduation:

College:

Name of College:

City:

State:

Zip:

Did You Graduate?

Yes

If Applicable, Year of Anticipated Graduation:

Degree:

Major Course of Study:

Graduate School:

Name of Graduate School:

City:

State:

Zip:

Did You Graduate?

Yes

If Applicable, Year of Anticipated Graduation:

Degree:

Major Course of Study:

Other Degrees, Certificates or Training:

Are you presently enrolled in any course or program of Education?

Yes

REFERENCES

Whenever possible, please include only those who have information relating to your qualifications for employment.

May we contact your present employer?

Yes

Reference 1:

Name:

Phone:

Relationship:

How Many Years Acquainted?

Reference 2:

Name:

Phone:

Relationship:

How Many Years Acquainted?

Reference 3:

Name:

Phone:

Relationship:

How Many Years Acquainted?

SALES EXPERIENCE

If you were to summarize your total sales experience, what would you say are your strong points and weak points?

What are your future goals?

Have you any other business interests which will continue if you come to work for us?

Yes

Do you have any business and/or personal relationships which may create a conflict of interest for you if you are hired by United Laboratories (for example, are you a party to a non-compete agreement, do you and/or your relatives work for a competitor of United Laboratories, etc.)?

Yes

NOTIFICATION AND AGREEMENT

I hereby affirm that the information given by me on this application is complete and accurate. I understand that the falsification, misrepresentation or omission of fact will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

I authorize the investigation of all statements with no liability.

If hired, I agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of the Company or myself and will abide by all company rules and regulations.

I affirm that I have read the following documents:

I understand that the completion of this Application for Employment does not obligate the Company to hire me.

We afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, veterans, and individuals with a disability, or any other characteristics protected by Federal, State or Local law.

Applicant Name:

Application for Employment - Sales

PERSONAL INFORMATION

EMPLOYMENT BACKGROUND

Begin with your most recent employment.

Job Number 2:

Job Number 3:

Job Number 4:

EDUCATION BACKGROUND

High/Prep School:

College:

Graduate School:

REFERENCES

Reference 1:

Reference 2:

Reference 3:

SALES EXPERIENCE

NOTIFICATION AND AGREEMENT