Personal Information

    Select artwork type

    Please select the most appropriate category for your painting

    FIRST NAME *

    LAST NAME *

    COMPLETION DATE

    EMAIL ADDRESS *

    PHONE NUMBER *

    SHIPPING ADDRESS *

    CITY *

    STATE *

    ZIP *

    Artwork Type

    HIGH SCHOOL

    NAME OF HIGH SCHOOL

    CITY

    STATE

    HOW MANY YEARS COMPLETED?

    GRADUATION/ DATES ATTENDED

    College {{rep-1_index}}

    NAME OF COLLEGE

    CITY

    STATE

    GRADUATION/ DATES ATTENDED

    DEGREE RECEIVED

    References

    PLEASE LIST THREE PROFESSIONAL REFERENCES

    Reference No. 1

    FULL NAME

    RELATIONSHIP

    COMPANY

    PHONE

    ADDRESS *

    CITY *

    STATE *

    ZIP *

    Reference No. 2

    FULL NAME

    RELATIONSHIP

    COMPANY

    PHONE

    ADDRESS *

    CITY *

    STATE *

    ZIP *

    Reference No. 3

    FULL NAME

    RELATIONSHIP

    COMPANY

    PHONE

    ADDRESS *

    CITY *

    STATE *

    ZIP *

    Employment

    EMPLOYER {{rep-3_index}}

    COMPANY NAME

    PHONE

    ADDRESS *

    CITY *

    STATE *

    ZIP *

    JOB TITLE

    STARTING SALARY

    ENDING SALARY

    RESPONSIBILITIES *

    REASON FOR LEAVING *

    SUPERVISOR *

    May we contact your supervisor? *YesNo

    Military Service

    Did you serve in the Military? *YesNo

    BRANCH

    FROM

    TO

    RANK AT DISCHARGE *

    TYPE OF DISCHARGE *

    IF OTHER THAN HONORABLE, EXPLAIN

    Signature

    DISCLAIMER & SIGNATURE

    I certify that my answers are true and complete to the best of my knowledge.

    If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

    Your typed name represents an eSignature *

    Date *

    Summary

    Please check the information below. If everything looks correct, press submit application.

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