| Name |
|
| Title |
|
| Organization |
|
| Street address |
|
| Address (cont.) |
|
| City |
|
| State/Province |
|
| Zip/Postal code |
|
| Country |
|
| Work Phone |
|
| Home Phone |
|
| FAX |
|
| E-mail |
|
| |
| EDUCATION |
| High School Name |
|
| Location (City/State) |
|
| Last Year Completed: |
|
| Did You Graduate? |
|
| Major or Specialty |
|
List
Abilities, Activities,
Honors, Hobbies |
|
| COLLEGE |
| College Name |
|
| Location (City/State) |
|
| Last Year Completed |
|
| Did You Graduate? |
|
| Major or Specialty |
|
List Abilities, Activities,
Honors, Hobbies |
|
| TRADE
SCHOOL |
| Trade School Name |
|
| Location (City/State) |
|
| Last Year Completed |
|
| Did You Graduate? |
|
| Major or Specialty |
|
List Abilities, Activities,
Honors, Hobbies |
|
|
|
| |
| PAST
EMPLOYMENT REFERENCES |
| Reference 1 |
| From Date |
|
| To Date |
|
| Name |
|
| Address |
|
| Telephone
Number |
|
| Job Title |
|
| Supervisor |
|
| Pay Rate |
|
| Reason for
Leaving |
|
|
| Reference 2 |
| From Date |
|
| To Date |
|
| Name |
|
| Address |
|
| Telephone
Number |
|
| Job Title |
|
| Supervisor |
|
| Pay Rate |
|
| Reason for
Leaving |
|
|
| Reference 3 |
| From Date |
|
| To Date |
|
| Name |
|
| Address |
|
| Telephone
Number |
|
| Job Title |
|
| Supervisor |
|
| Pay Rate |
|
| Reason for
Leaving |
|
|
| Reference 4 |
| From Date |
|
| To Date |
|
| Name |
|
| Address |
|
| Telephone
Number |
|
| Job Title |
|
| Supervisor |
|
| Pay Rate |
|
| Reason for
Leaving |
|
|
|
| |
| MISC INFORMATION |
|
|
| I can begin working full-time on |
|
| I can work full-time until |
|
| I am available weekends
beginning |
|
| I am unavailable weekends after |
|
| I will attend school in the fall |
|
| If yes, where? |
|
| I can work: |
|
| Saturday |
|
| Sunday |
|
| Part-time |
|
*NOTE: Your availability dates are very important. Please give serious considerations to the dates you choose because they
will have a strong bearing on you application. Failure to comply with the dates you choose may affect future employment.
status.
|
|
|
| A LITTLE
ABOUT YOURSELF |
| Are you employed elsewhere?
|
| If so, where? |
|
Do you
have any special
abilities, awards, hobbies? |
|
| Do you have a valid driver's
license? |
|
| Are you
fluent in a language other than English?
|
| If so, which? |
|
| In case of
an emergency, who should we notify? |
| Name |
|
| Phone |
|
| Relationship |
|
| Address |
|
|
|
|
| Have you worked for us before? |
|
| If yes, when and who was your
supervisor? |
|
| Reason for leaving? |
|
| |
|
You May
Check My References |
|
You May NOT
Check My References |
I CERTIFY,
by hitting 'Submit Form,' that this information is accurate and complete. Giving
incomplete or false
information for employment is a serious matter and is grounds for
dismissal and forfeiture of related benefits.
|
|
|
