face="Arial"><input type="text" name="Salary3" size="6"></font></td>
<td width="24%" rowspan="2" height="52" align="center"><font size="1" face="Arial"><textarea rows="2" name="Position3" cols="20"></textarea></font></td>
<td width="27%" rowspan="2" height="52" align="center"><font size="1" face="Arial"><textarea rows="2" name="Reason for Leaving3" cols="20"></textarea></font></td>
</tr>
<tr>
<td width="16%" align="left" height="23">
<p align="left"><b><font size="1" face="Arial">To:
<input type="text" name="T1" size="10"></font></b></p>
</td>
</tr>
<tr>
<td width="16%" align="left" height="23">
<p align="left"><b><font size="1" face="Arial">From: <input type="text" name="T1" size="10"></font></b></p>
</td>
<td width="24%" rowspan="2" height="52" align="center"><font size="1" face="Arial"><textarea rows="2" name="S1" cols="20"></textarea></font></td>
<td width="10%" rowspan="2" height="52" align="center"><font face="Arial"><input type="text" name="Salary4" size="6"></font></td>
<td width="24%" rowspan="2" height="52" align="center"><font size="1" face="Arial"><textarea rows="2" name="Position4" cols="20"></textarea></font></td>
<td width="27%" rowspan="2" height="52" align="center"><font size="1" face="Arial"><textarea rows="2" name="Reason for Leaving3" cols="20"></textarea></font></td>
</tr>
<tr>
<td width="16%" align="left" height="23">
<p align="left"><b><font size="1" face="Arial">To:
<input type="text" name="T1" size="10"></font></b></p>
</td>
</tr>
</table>
</center>
</div>
<p align="left"> </p>
<p align="left"><font face="Arial" size="2"><b>REFERENCES</b></font></p>
<p align="left"><font face="Arial" size="1"><b>Give below the names of
three persons not related to you, whom you have know at least one
year.</b></font></p>
<div align="center">
<center>
<table border="1" width="95%">
<tr>
<td width="27%" align="center"><b><font size="1" face="Arial">Name</font></b></td>
<td width="29%" align="center"><b><font size="1" face="Arial">Address</font></b></td>
<td width="33%" align="center"><b><font size="1" face="Arial">Business</font></b></td>
<td width="12%" align="center"><b><font size="1" face="Arial">Years
Know</font></b></td>
</tr>
<tr>
<td width="27%" align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-name1" size="30"></font></b></td>
<td width="29%" align="center">
<p align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-address1" size="26"></font></b></td>
<td width="33%" align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-business1" size="26"></font></b></td>
<td width="12%" align="center">
<p align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-years1" size="2"></font></b></td>
</tr>
<tr>
<td width="27%" align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-name2" size="30"></font></b></td>
<td width="29%" align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-address2" size="26"></font></b></td>
<td width="33%" align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-business2" size="26"></font></b></td>
<td width="12%" align="center">
<p align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-years2" size="2"></font></b></td>
</tr>
<tr>
<td width="27%" align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-name3" size="30"></font></b></td>
<td width="29%" align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-address3" size="26"></font></b></td>
<td width="33%" align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-business3" size="26"></font></b></td>
<td width="12%" align="center">
<p align="center"><b><font size="1" face="Arial"><input type="text" name="Reference-years3" size="2"></font></b></td>
</tr>
</table>
</center>
</div>
<p align="left"><b><font size="3" face="Arial">Authorization</font></b></p>
<p align="left"><b><font size="1" face="Arial">"I certify that
the facts contained in this application are true and complete to the
best of my knowledge and understand that, if employed, falsified
statements on this application shall be grounds for dismissal.</font></b></p>
<p align="left"><b><font size="1" face="Arial">I authorize
investigation of all statements contained herein and the references
and employers listed above to give you any and all information
concerning my previous employment and any pertinent information they
may have, personal or otherwise, and release the company from all
liability for any damage that may result from utilization of such
information.</font></b></p>
<p align="left"><b><font size="1" face="Arial">I also understand and
agree that no representative of the company has any authority to enter
into any agreement for employment for any specified period of time, or
to make any agreement contrary to the foregoing, unless it is in
writing and signed by an authorized company representative.</font></b></p>
<p align="left"><b><font size="1" face="Arial">This waiver does not
permit the release or use of disability-related or medical information
in a manner prohibited by the Americans with Disabilities Act (ADA)
and other relevant federal and state laws."</font></b></p>
<p align="left"> </p>
<form method="POST" enctype="text/plain" action="mailto:
[email protected]" name="Test" onSubmit name="Employment" enctype="text/plain">
<p align="center"><a href="mailto:
[email protected]"><input type="submit" value="Send the Application" name="Email"></a>
<input type="reset" value="Reset" name="B2"></p>
</form>
<p>
</td>
<td width="2%" valign="bottom">
</td>
</tr>
</table>
</div>
[/HTML]