I am applying for:      Sales Rep Technician

Personal Information

Name

Current Address

City

State

Zip

Permanent Address

City

State

Zip

Home Phone

Mobile Phone

If under 18, please list your age

Have you ever been convicted of a felony?
YesNo

If you answered YES, please list the number of convictions, nature of offense(s), date(s) of convictions, sentence(s) imposed, and type(s) of rehabilitation.

What school do you attend?

Date available for Work
January February March April May June July August September October November December    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    2007 2008 2009

Do you have door-to-door sales experience?
 YESNO

If “YES”, what company?

Years worked

Name of supervisor

# of Accounts Sold

REFERENCES
Please provide two (2) references other than relatives or previous employers. Please be sure that telephone numbers are current.

Reference 1 Name

Address

City

State

Zip

Phone

Years Known

Reference 2 Name

Address

City

State

Zip

Phone

Years Known

SKILLS & QUALIFICATIONS
Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for direct sales. These may include leadership experiences, civic or academic, i.e. sports, clubs, community service, etc.
(Please be specific.)