Full Name: Present Address: City, State, Zip: Phone Number: Email Address: Do you have any physical condition which may limit your ability to perform the particular job you are applying for? If Yes, please explain:   What method of transportation will you use to get to work?:   Positions(s) applied for: Rate of pay expected per week $:   Full Time or Part Time: Full Time Part Time Speciify days and hours if Part-Time:   Were you Previous Employed by us? If yes, when?:   List any friends or relatives working for us, other than sposue:   On what date are you available to start?:   Are there any other skills, or qualifications which you feel can contribute to our organization?:     Elementary School: Last Year Completed: 5 6 7 8 Did you Graduate: Yes No   High School: Course of Study: Years Completed: 1 2 3 4 Did you Graduate: Yes No List Diploma or Degree:   College: Course of Study: Last Year Completed: 1 2 3 4 Did you Graduate: Yes No List Diploma or Degree:   Other:   Please attach a resume if you have one:

Impressions Inc.
11360 Bluegrass Parkway • Jeffersontown, KY 40299-2346
Phone: (502) 266-6008 • Fax: (502) 266-6201
E-mail: jshortt@impressionsinc.biz