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Merit

orporation EMPLOYMENT APPLICATION

Complete the application online from the FBLA-PBL Web site. Use the tab key to move through the ocument.

GENERAL INFORMATION
Name (Last) Address (Mailin Address) (First) (Middle Initial) Home Telephone

(Cit!) ("tate) (#ip)

!" -
Cell Phone

E$mail Address

!" -

PO"ITION
Position or T!pe o% Emplo!ment &esired

%ave you ever been employe at the &erit Corporation before' (es )o

'ill A((ept) Part-#ime $ate Available

Full-#ime

Are you able to perform the essential functions of the *ob you are applying for+ ,ith or ,ithout reasonable accommo ation' (es )o
"alar! &esired

E&*CATION AN& TRAINING


"(hool or Name and Address o% "(hool Instit+tion Hi h "(hool Colle e Colle e Other "pe(ial A-ilities and ".ills E/tra(+rri(+lar A(ti0ities

Ma,or

Year Grad+ated

&e ree

Pro%essional Certi%i(ates or Li(enses Held Present Comm+nit! and Pro%essional A%%iliations

Lan +a es Read1 'ritten or "po.en Fl+entl! Other Than En lish

REFERENCE"
List belo, names an a resses of persons ,ho are -ualifie to ans,er -uestions concerning your fitness for the position!s" you seek other than those liste in your cre ential file.

Name

Position

Address

Telephone

'OR2 E3PERIENCE4Most recent first, include voluntary work and military experience
AN EQUAL OPPORTUNITY EMPLOYER

Emplo!er Address 6o- Title "pe(i%i( &+ties (Ma/im+m 789 (hara(ters)

Telephone N+m-er !" - N+m-er Emplo!ees "+per0ised

From (Month5Year) To (Month5Year) Ho+rs Per 'ee. Last "alar! "+per0isor

Reason For Lea0in

Emplo!er Address 6o- Title "pe(i%i( &+ties (Ma/im+m 789 (hara(ters)

Ma! 'e Conta(t This Emplo!er: (es )o Telephone N+m-er !" - From (Month5Year) N+m-er Emplo!ees "+per0ised To (Month5Year) Ho+rs Per 'ee. Last "alar! "+per0isor

Reason For Lea0in

Emplo!er Address 6o- Title "pe(i%i( &+ties (Ma/im+m 789 (hara(ters)

Ma! 'e Conta(t This Emplo!er: (es )o Telephone N+m-er !" - From (Month5Year) N+m-er Emplo!ees "+per0ised To (Month5Year) Ho+rs Per 'ee. Last "alar! "+per0isor

Reason For Lea0in

Ma! 'e Conta(t This Emplo!er: )o

(es

I (erti%! the in%ormation (ontained in this appli(ation is tr+e1 (orre(t1 and (omplete; I +nderstand that1 i% emplo!ed1 %alse statements reported on this appli(ation ma! -e (onsidered s+%%i(ient (a+se %or dismissal;

.ignature of Applicant///////////////////////////////////////////////////////// $ate////////////////

AN EQUAL OPPORTUNITY EMPLOYER

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