| Nominee’s Name ___________________________________________________________ |
| Date_____________________________________________________________________ |
| Telephone_________________________________________________________________ |
| Address __________________________________________________________________
City __________________________ State _________________ Zip _________________ |
| Sex: Male Female |
| Date of Birth _________________________ |
| Educational High School ______________________
College __________________________ _________________________________________________________________________ |
| Other Experience - Drycleaning Plants
Name of Plant _____________________________________________________________ |
| Date of Employment ____________________ Title________________________________
Use additional pages if necessary |
| Areas of Experience Check all that apply Drycleaning Spotting Finishing Sales Marketing/Checking Maintenance Office |
| Years in Drycleaning Industry ____________________________
Other Interests ______________________________________________________________ |
| Current Employment
Address __________________________________________________________________ City __________________________ State _________________ Zip _________________ |
| Telephone_________________________________________________________________ |
| Signature-Applicant ___________________ Signature-Owner/Manager__________________ |
