3
SPECIAL QUALIFICATIONS AND SKILLS (please describe any specialized training and skills, professional
licenses and certificates, publications, scholastic honors, foreign languages, etc.):
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
PROFESSIONAL, TRADE, BUSINESS, OR CIVIC ACTIVITIES AND OFFICES HELD (you may
exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other
protected status):
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
EMPLOYMENT EXPERIENCE: Start with your present job and work back, include military and volunteer
experience. Additional experience should be listed by attaching separate sheets of paper or a personal resume.
Be sure to include all requested information.
Present Employer ____________________________________________________________________
Address____________________________________________________________________________
Phone Number (____) _____________________ Fax (____) _____________________
Job Title ________________________ Starting Salary _________ Present/Ending Salary _________
Dates of Employment: From _____________ to _____________ Hours per week _________
Supervisor’s Name ___________________________________________________________________
Reason for Leaving ___________________________________________________________________
Work Description ____________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________