14 Sanford Rd. North · Churchville, NY 14428 · 585-293-2650 · Fax 585-293-2130 · http://www.qualicoat.com · info@qualicoat.com

Employment Application


Notice to Applicants:
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.

Please provide the following employment information:

            Name 
Social Security #
  Street address 
 Address (cont.) 
            City 
  State/Province 
 Zip/Postal code 
           Phone 
             FAX 
          E-mail 
             URL 

Have you been convicted of a felony within the last 7 years? Yes  No



If yes, explain:
(Conviction will not necessarily disqualify applicant for employment.)





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Last modified on Aug. 11, 2005
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