Instructions: Print clearly in black or blue ink. Answer all questions. Sign and date the form.
PERSONAL INFORMATION:
Name (last name, first name, middle initial) __John Robert Doe___________________________
Social Security # _____________________________555772222__________________________
Street Address _123 Main Street___________________________________________________
City, State, Zip Code___St. Joseph 64934__________________________________________
Phone Number (___)__555-9911_________________________
Date of Birth
__April 16____________________________________
Are you eligible to work in the United States? Yes _______ No_______
Have
you been convicted of or pleaded no contest to a felony within the last five
years? Yes_______
No_______
If yes, please explain:
_____________________________________________________________
POSITION/AVAILABILITY:
Position Applied For ___Dairy King_________________________________________________
Days/Hours Available Sun. ____ Mon.
_X_ Tues. _X_ Wed. _X__ Th. _X_ Fri. _X_ Sat.
____
Hours Available: from __6_____ to __10____
What date are you available to start work?____Monday________________________________
EDUCATION:
Name And Address Of School:
____St. Joseph High School__________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Skills And Qualifications: Licenses, Skills, Training, Awards
_____Don’t got none________________________________________________________________________
_________________________________________________________________________________________
EMPLOYMENT HISTORY:
Present Or Last Position:
Employer: __Burger Hut_____________________________________________________________________
Address: ___The one on Jackson Street_________________________________________________________
Supervisor: __Mr. Martin____________________________________________________________________
Phone: ___333-6665___________ ___________Email: __AOL ________________________________
Position Title: __Line guy___________________________________________________________________
From: __June 2005__________________________ To: __October___________________________________
Responsibilities: _Took orders________________________________________________________________
Salary: _6.50_________ Reason For Leaving: __Got mad at boss____________________________________
Previous Position:
Employer: ___Car Wash_____________________________________________________________________
Address: ___Elm Street in St. Joseph____________________________________________________________
Supervisor: ____Marvin______________________________________________________________________
Phone: _______________________________ Email: ______________________________________________
Position Title: __Car Washer__________________________________________________________________
From: _Saturday________________________ To: ___Sunday_______________________________________
Responsibilities: __Wash cars_________________________________________________________________
Salary: _$5____________ Reason For Leaving: _Got tired of the job__________________________________
Previous Position:
Employer: ________________________________________________________________________________
Address:__________________________________________________________________________________
Supervisor: ________________________________________________________________________________
Phone: _______________________________ Email: ______________________________________________
Position Title: ______________________________________________________________________________
From: ________________________________ To: ________________________________________________
Responsibilities: ___________________________________________________________________________
Salary: _______________ Reason For Leaving: __________________________________________________
May We Contact Your Present Employer? Yes _____ No __X__
References:
Name/Title Address Phone Occupation
_Jane Doe_____________123 Main St.________555-9911_______________My mother_________________
_________________________________________________________________________________________
_________________________________________________________________________________________
I certify that information contained in this application is
true and complete. I understand that false information may be grounds for not
hiring me or
for immediate termination of employment at any point in the future if I am
hired. I authorize the verification of any or all information listed above.
Signature______________________________ Date __May 15_________________________