Form Experiment

Simple test to see if I can create forms, save the data from them, and e-mail that data in a easily readable format.

Personal Information

First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Email:
Phone Number:
Are you a U.S. Citizen? Yes No
Have you ever been
convicted of a felony?		 Yes No
If selected for employment
are you willing to submit
to a Pre-Employment
Drug Screening Test?		 Yes No

Position

Position(s) you are applying for:
Available Start Date:
Employment Desired: Full Time
Part Time
Seasonal/Temporary

Education

School Name Location Years Attended Degree Recieved Major

References

Name Title Company Phone

Employment History

Employer(1)
 Job Title:
 Dates Employed
From: To:
Work Phone:
 Starting Pay Rate:
 Ending Pay Rate:
Street Address:
 City:

State:
 Zip:
Employer(2)
 Job Title:
 Dates Employed
From: To:
Work Phone:
 Starting Pay Rate:
 Ending Pay Rate:
Street Address:
 City:

State:
 Zip:
Employer(3)
 Job Title:
 Dates Employed
From: To:
Work Phone:
 Starting Pay Rate:
 Ending Pay Rate:
Street Address:
 City:

State:
 Zip:
Employer(4)
 Job Title:
 Dates Employed
From: To:
Work Phone:
 Starting Pay Rate:
 Ending Pay Rate:
Street Address:
 City:

State:
 Zip:

Submission Disclaimer

By submitting this applicaiton, I certify that my answers and 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.

Full Name:
 Today's Date: