Name*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Experience*

Company / Business Name	City, State, Country	Occupation / Title	Duties and Responsibilities	Wages / Salary	Month / Year Employed	Month / Year Employment Ended	Reason for Leaving

Education

Institution	Degree	Major	City, State, Country	Month / Year Started	Month / Year Graduated

Special Skills and Qualifications*

Salary Preference*

Salary Expectations (USD)*

Languages

Language	Proficiency Level

Which office(s) do you want to be considered for employment?*

Are you authorized to work in the selected location(s)?*

Please clarify your previous answer*

Have you ever been convicted, pleaded guilty or no contest to a crime, or are criminal charges pending against you?*

Please clarify your previous answer*

Have you ever been terminated from or asked to leave any previous position?*

Please clarify your previous answer*

Do you have a valid driver's license?*

All employment positions at Kaw Valley Engineering require a valid driver's license.

Have you ever been ticketed for a traffic violation?*

Please list the approximate date(s) and miles over the speed limit for each ticket*

Have you ever had your driver's license suspended, revoked and/or denied?*

Please explain the nature and approximate dates for each*

Have you ever received any other driving related tickets?*

Please explain the nature and approximate dates for each*

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