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	EMPLOYMENT APPLICATION Western Pump, Inc. 3235 "F" Street San Diego CA 92102-3315 We are an Equal Opportunity Employer. All applicants are considered without regard to race, color, religion, disability, sex, national origin, age (for those age 40 or over), or any other basis protected by federal, state, or local law. This employment application is only active for 30 days. After this time period a separate employment applicaton must be submitted in order to be considered for employment. Date:   123456789101112/ 12345678910111213141516171819202122232425262728293031/ 2012201320142015 PERSONAL First:   Middle:   Last:   Street Address:   City:    State:  Click here AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY  Zip:  Social Security No.:   Phone:   ()- Email:   How did you find out about us?  Newspaper   Referral   (name of referral):   Other  (please specify):  If hired, do you have a reliable means of transportation to get to work?  Yes  No What is it?  Minimum salary expected:  Are you at least 18 years old?  Yes  No If the job you are applying for requires driving: Driver's License No.:   State Issued:   Click here AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Expiration Date:   Month:  123456789101112  Year:  20122013201420152016201720182019202020212022202320242025 Are you legally eligible for employment in the U.S.?  Yes  No (Proof of U.S. citizenship or immigration status will be required if hired.) Have you been convicted of a crime? (Massachusetts applicants should not include misdemeanor convictions; California applicants should not include marijuana-related convictions that occurred more than 2 years prior to the application date.)  Yes  No If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.) page: 1