| Personnel Notes: (These notes are open to
inspection-keep information factual) |
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| If applicant is 18 yrs. old or less is proof
of age on file? Y__ N__ |
| Interviewers
Signature: |
Date: M__D__Y__ |
| Starting Date: |
Completion of probation date: |
| Exempt__ |
Non-Exempt__ |
| Department: |
Cost Center: |
Signature: |
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| Position/Job Site: |
Full Time__ |
On Call Status |
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Part Time__ |
Rotation:__ |
| Starting Salary/Grade: |
| Differential |
Shift |
Employee Number |
| Notify for Emergency-Name: |
Relationship: |
Address: |
Telephone: |
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| Notify for Emergency-Name: |
Relationship: |
Address: |
Telephone: |
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