Employment Application

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:		9 10 11 12
Did You Graduate?		Yes No
Major or Specialty
List Abilities, Activities, Honors, Hobbies
COLLEGE
College Name
Location (City/State)
Last Year Completed		1 2 3 4
Did You Graduate?		Yes No
Major or Specialty
List Abilities, Activities, Honors, Hobbies
TRADE SCHOOL
Trade School Name
Location (City/State)
Last Year Completed		1 2 3 4
Did You Graduate?		Yes No
Major or Specialty
List Abilities, Activities, Honors, Hobbies
Do you have any special activities which start late in the summer, such as football or soccer practice, college orientation, etc.? If so, list and give approximate starting dates
Can you operate:
	WPM?		A cash register?
	A typewriter		An adding machine?
PAST EMPLOYMENT REFERENCES
Reference 1
Dates:   From
To
Name
Address
Telephone Number
Job Title
Supervisor
Pay Rate
Reason for Leaving
Reference 2
Dates:   From
To
Name
Address
Telephone Number
Job Title
Supervisor
Pay Rate
Reason for Leaving
Reference 3
Dates:   From
To
Name
Address
Telephone Number
Job Title
Supervisor
Pay Rate
Reason for Leaving
Reference 4
Dates:   From
To
Name
Address
Telephone Number
Job Title
Supervisor
Pay Rate
Reason for Leaving
Reference 5
Dates:   From
To
Name
Address
Telephone Number
Job Title
Supervisor
Pay Rate
Reason for Leaving
Reference 6
Dates:   From
To
Name
Address
Telephone Number
Job Title
Supervisor
Pay Rate
Reason for Leaving
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		Yes No
If yes, where?
I can work:
Saturday		Yes No
Sunday		Yes No
Part-time		Yes No
*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? Yes No
If so, where?
Do you have any special abilities, awards, hobbies?
Do you have a valid driver's license?		Yes No
Are you fluent in a language other than English? Yes No
If so, which?
In case of an emergency, who should we notify?
Name
Phone
Relationship
Address:
Have you worked for us before?		Yes No
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.