Employment Application 2

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Employment Application

Applicant Information
Full Name:

Adams
Last

Address:

Jaylond

First

M.I.

513 Rose hill road


Street Address

Phone:

Date:02/22/16

Apartment/Unit #

Birmingham

Al

35214

City

State

ZIP Code

(205)370-0874

Date Available:

03/01/16

Email [email protected]
Social Security No.:656-27-4123

Desired Salary:$7.75

Position Applied for: cook


Are you a citizen of the United States?
Have you ever worked for this company?
Have you ever been convicted of a felony?

YES

NO

YES

NO

YES

NO

If no, are you authorized to work in the U.S.?


If yes, when?

If yes, explain:

Education
High School:
From:

Minor High School


To:

College:
From:

Did you graduate?

YES

NO

YES

NO

YES

NO

Diploma::

Address:
To:

Other:
From:

Address:2285 Minor pkwy

Did you graduate?

Degree:

Address:
To:

Did you graduate?

Degree:

YES

NO

References
Please list three professional references.
Full Name: George Bates
Company:

Jefcoed

Address:

2285 Minor Pkwy

Relationship: Coach
Phone:(205)230-3433

Full Name:

Relationship:

Company:

Phone:

Address:
Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment
Company:

Jacks fast food restaurant

Address:

5701 Adamsville Pkwy

Job Title:

cook

Phone:(205)674-6543
Supervisor:cody
Starting Salary:$7.75

Ending Salary:$7.75

Responsibilities: Cook, clean, and stock


From:

June

To:July

Reason for Leaving:Injured


YES

May we contact your previous supervisor for a reference?


yes

NO

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:$

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:


YES

May we contact your previous supervisor for a reference?

Company:

Phone:

Address:
Job Title:

NO

Supervisor:
Starting Salary:$

Responsibilities:
2

Ending Salary:$

From:

To:

Reason for Leaving:


YES

May we contact your previous supervisor for a reference?

NO

Military Service
Branch:

From:

Rank at Discharge:

To:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature


I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or
interview may result in my release.
Signature:

Jaylond Adams

Date:02/22/16

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