EMPLOYMENT
DATE
APPLICATION
POSITION APPLIED FOR
100 W. California Ave.
Ridgecrest, CA 93555
Last Name
First Middle Social Security No.
P
E
Street Address
Home Phone
R
S
City, State, Zip
Business Phone
O
N
Are you legally eligible for employment in the United States? Will you work overtime if asked? Hourly Salary Desired
A
Yes
No
Yes No
L
Apart from absence for religious observance, are you available for full-time work? When will you be available to begin work?
Yes
No If not, what hours can you work?
EMPLOYMENT
This section must be completed in full. Additional resume may be attached, but not required. Please give accurate, complete full-time
and part-time employment record. Start with present or most recent employer.
Company Name
Telephone
Address
Employed (State Month and Year)
1
From To
Name of Supervisor
State Job Title and Describe Duties and Responsibilities
Reason for Leaving
Company Name
Telephone
Address
Employed (State Month and Year)
2
From To
Name of Supervisor
State Job Title and Describe Duties and Responsibilities
Reason for Leaving
Company Name
Telephone
Address
Employed (State Month and Year)
3
From To
Name of Supervisor
State Job Title and Describe Duties and Responsibilities
Reason for Leaving
We may contact the employers listed above unless
Do not contact
you indicate those you do not want us to contact.
Employer #
Reason
Front
