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.
|
|
|