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 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.

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