Name:________________________________________________________________ Last First Middle If you have worked under another name, please give name._____________________
Home Phone________________________ Cell_______________________________
Position applied for:_________________________ Expected rate of pay____per hour ___Full time ___ Part time When are you available to start__________________ Are you 18 years of age or older?__________________________________________ If hired, can you provide proof of eligibility to work in the United States? _________ Have you every been convicted of a felony? _______ A yes answer doen not necessarily disqualify you from employment.
Education Record High School___________________________ Graduated?___________ College_______________________________Graduated?_______ Degree_________ Business or Trade School________________Graduated?_______ Degree_________ Other:_________________________________________________________________ Are you currently attending school?_________________________________________ Do you have plans to return to school?_______________________________________
Work History Begin with most recent employment and include military experience. Company: _____________________ Address:__________________Phone__________ Type of business:________________Job Title:__________ Supervisor:_____________ Employment Started________ Ended_______ Rate of Pay at Start_____ End________ Description of duties:______________________________________________________ Reason for leaving:_______________________________________________________
Company:______________________Address:__________________Phone__________ Type of business:________________ Job Title:__________Supervisor_____________ Employment Started________Ended_______ Rate of Pay at Start_____End_________ Description of Duties:_____________________________________________________ Reason for leaving:_______________________________________________________
Company:______________________Address:_________________ Phone__________ Type of business;________________ Job Title:__________Supervisor____________ Employment Started________Ended_______Rate of Pay at Start_____End________ Description of Duties:____________________________________________________ Reason for leaving:______________________________________________________
Describe skills you have that may qualify you for this position:___________________ _______________________________________________________________________
What kind of work environment do you desire in a new situation?_________________ _______________________________________________________________________
How does this postion fit into your long-term career objectives?__________________ _______________________________________________________________________
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