| PERSONAL DATA |
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| Are you available for out of town work? |
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| Will you work overtime, if required? |
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| Are you legally authorized to work in the United States? |
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Will you now or in the future require sponsorship
for employment visa status? |
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Have you been named as a defendant in a civil
action for an intentional tort? |
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| If yes, please describe the nature of the tort and the disposition of the action |
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| (Answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as date of the incident, seriousness and nature of the violation, rehabilitation and positon applied for will be taken into account.) |
| Have you taken any illegal drugs within the last 30 days? |
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| If yes, please explain: |
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