Employment

Name*
First Last
Date
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Social Security Number*
Date Available to Start
MM slash DD slash YYYY
Position Applied For*
Desired Wage*
Are you a citizen of the U.S.?*
- Yes
- No
If no, are you authorized to work the U.S.?
- Yes
- No
Have you ever worked for Glen Ellyn Storage?
- Yes
- No
If Yes, when?
Are you able to perform the essential functions of the job for which you are applying? (With or without reasonable accommodation.)
- Yes
- No
- Need more information about the job
This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation or if accommodation is necessary. These issues may be addressed at a later stage tot he extent permitted by the law.
How did you hear about this position?
Educational Background
List
School (+city/state) Years completed Graduate? Degree
References (Not related to you that you have known for at least a year)
List at least 3
Name Relationship to you City/State Phone Email # of years known
Employment History
Start with your present or last job. Include any job-related military service assignments and volunteer activities.
Company Name & Address
From - To
Phone
Job Title
Ending wage/salary
May we contact the Co.?
- Yes
- No
Supervisor's name
Supervisor's title
Describe your job responsibilities
Reason for leaving

465 E. Fullerton, Carol Stream, IL 60188
Carol Stream: (630) 543-0500
Chicago: (773) 854-4060
IL ICC# 53545 ICC# MC2934
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School (+city/state)	Years completed	Graduate?	Degree

Name	Relationship to you	City/State	Phone	Email	# of years known

Employment History