© 2008 Barnett Southern Corp. All Rights Reserved.
BARNETT SOUTHERN CORPORATION
P. O. Box 704, Washington, GA 30673

ONLINE APPLICATION FOR EMPLOYMENT
We do not discriminate on the basis of race, color, gender, religion, national origin, age, marital or veteran
status, mental or physical disability unrelated to job performance or any other legally protected status.
Position Applying for
Date
PERSONAL INFORMATION
Legal Name:
First
Last
Middle Initial
Address:
Street
City
State
Zip
Phone:
Home
Cell
Email:
Social Security No.
Driver's License No.
State
(If position requires operation of a company vehicle)
Are you legally eligible for employment in the United States?
If hired, can you furnish proof that you are eligible to work in the United States?
Have you been convicted of a felony?
If yes, please explain circumstances:
Are you at least 18 years old?
The Diamond on Your Site
Answering "yes" to these questions does not constitute and automatic rejection for employment.
Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
POSITION INFORMATION
Position(s) Applying for:
Salary desired:
Employment status desired:
If hired, when could you start?
How did you hear about this job?
EMPLOYMENT HISTORY (most recent first)
1. Job Title:
Duties:
Employer:
Dates of Employment (month/year)
From:
To:
Starting Salary:
Ending Salary:
Employer's Address:
Supervisor:
May we contact?:
Phone:
Reason for Leaving:
2. Job Title:
Duties:
Employer:
Dates of Employment (month/year)
From:
To:
Starting Salary:
Ending Salary:
Employer's Address:
Supervisor:
May we contact?:
Phone:
Reason for Leaving:
3. Job Title:
Duties:
Employer:
Dates of Employment (month/year)
From:
To:
Starting Salary:
Ending Salary:
Employer's Address:
Supervisor:
May we contact?:
Phone:
Reason for Leaving:
4. Job Title:
Duties:
Employer:
Dates of Employment (month/year)
From:
To:
Starting Salary:
Ending Salary:
Employer's Address:
Supervisor:
May we contact?:
Phone:
Reason for Leaving:
EDUCATION
High School
Name and Location:
Dates Attended:
From:
To:
Degree Received:
Subjects Studied:
Did You Graduate?
Yes
No
Yes
No
Yes
No
Yes
No
Full Time
Part Time
Temporary
Full Time
Part Time
Temporary
Yes
No
Full Time
Part Time
Temporary
Yes
No
Full Time
Part Time
Temporary
Yes
No
Full Time
Part Time
Temporary
Yes
No