APPLICATION FOR STUDENT TRAINEESHIP PROGRAM EM 831 (REV 05/09)

PRINT NAME (Family Name) (First Name) (Middle Name) CITIZENSHIP

ADDRESS CP/ TEL. NO. E-MAIL ADDRESS

AGE DATE OF BIRTH (mm/dd/yyyy) PLACE OF BIRTH SEX HEIGHT WEIGHT

CIVIL STATUS SINGLE WIDOWED FULL NAME OF SPOUSE NO OF CHILDREN SSS NO TIN NO.

MARRIED SEPARATED

SPEAK WRITE READ

TELEPHONE NO

RELATIONSHIP

RELATIVE(S) CURRENTLY/ NAME COMPANY/LOCATION RELATIONSHIPPREVIOUSLY EMPLOYEDBY EDC

HAVE YOU EVER APPLIED WITH APPLIED ONLY IF EMPLOYED, INDICATE WHEN/ WHERE/ POSITION

OR BEEN EMPLOYED BY THIS COMPANY? EMPLOYED

PER

SON

AL

WO

RK

EXP

ERIE

NC

E

VOCATIONAL

TYPE OF SCHOOL

ELEMENTARY

HIGH SCHOOL

COLLEGE OR UNIVERSITY

ATHLETIC ACTIVITIES

AC

TIVI

TIES

EDU

CAT

ION

NATURE OF WORKMONTHLY SALARY

(Upon Leaving)

NAME & ADDRESS OF EMPLOYER INCLUSIVE DATES

SCHOLASTIC HONOR/SNAME OF SCHOOL & LOCATION DEGREE & MAJOR

IN CASE OF EMERGENCY, NOTIFY

YEAR GRADUATED

ACTIVITIES OTHER THAN ATHLETICS (Publications, Class Organization, Clubs, etc.)

NAME

ADDRESS

HOBBIES & OUTSIDE INTEREST(College Sports) (Including Civic Activities)

PHOTO 1" X 1"

LANGUAGES AND DIALECTS

WHAT OFFICE MACHINES CAN YOU OPERATE?

OTHER SPECIAL ABILITIES?

ANY SERIOUS ILLNESS? WHEN?

ANY PHYSICAL DEFECT OR WEAKNESS?

WHAT TYPE OF WORK WOULD YOU LIKE TO GET INTO EVENTUALLY?

HOW LONG/ HOW MANY HOURS DO YOU INTEND TO PURSUE YOUR TRAINEESHIP PROGRAM?

WHEN WILL YOU BE AVAILABLE TO START?

PRINTED NAME SIGNATURE DATE

REMARKS

YRS KNOWN

OTH

ER IN

FOR

MAT

ION

HR

MD

USE

ON

LYST

UD

ENT

TR

AIN

EE'S

UN

DER

TAK

ING

NAME ADDRESS TEL NUMBER

CH

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AC

TER

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EFER

ENC

E

I hereby affirm that the information on this record are true, and that I have withheld nothing from the Company. Should any entry be found erroneous, I take full responsibility, and may be considered sufficient ground to cause my termination from the Company. For this reson, I authorized the Company to verify said given information.