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Genapp 1

Aviud Meza has applied for an unspecified position. He provides his contact information as well as availability to work various shifts. Meza has some past work experience but does not specify employers or dates of employment. His education consists of completing high school. As part of the application process, he provides references and acknowledges that references may be checked. Meza agrees to the terms described for processing his employment application.

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27 views

Genapp 1

Aviud Meza has applied for an unspecified position. He provides his contact information as well as availability to work various shifts. Meza has some past work experience but does not specify employers or dates of employment. His education consists of completing high school. As part of the application process, he provides references and acknowledges that references may be checked. Meza agrees to the terms described for processing his employment application.

Uploaded by

api-313099154
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Employment

Application

COMPANY OR EMPLOYER NAME:


Position applying for:

EMPLOYEE INFORMATION
Name:

aviud

meza

Last
Telephone: (619) 345-7805
Address:

First

Middle
Alternate telephone:

Email: [email protected]

1638 Tucker ave.

Are you able to perform the essential functions of


the position with or without accommodations?
Yes

No

If necessary for the job are you older than:


14

15

16

18

X 19

21

(Check one)

If necessary for the job, I am able to:


Work overtime?
X Yes
Yes
Provide a valid Alaska Driver's License?
If so, fill out the following:
Issuing state:
Type:
Endorsement(s):

I am legally eligible for employment in the U.S.?


X Yes

No

I am seeking a permanent position:

Yes X No

Hazardous Material

No
X No

Passengers

Tankers

Tank with Hazardous Materials

School Bus

Double/Triple trailers

Work the following shifts: (check all that apply)

I will be able to report to work


3 days after being notified I am hired.

X Any

Split

Day

Night

Graveyard

Swing

Rotating

Other:

EMPLOYMENT HISTORY
List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed
here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.

Employer name and address:

Position title/duties, skills:

Start date:

End date:

Reason for leaving:


Pay: $
Per:
Employer name and address:

Supervisor:
Position title/duties, skills:

Telephone:
Start date:

End date:

Reason for leaving:


Pay: $
Per:
Employer name and address:

Supervisor:
Position title/duties, skills:

Telephone:
Start date:

End date:

Reason for leaving:


Pay: $
Per:
Employer name and address:

Supervisor:
Position title/duties, skills:

Telephone:
Start date:

End date:

Reason for leaving:


Pay:
Per:

Rev. 8/2010

Supervisor:

Telephone:
Employment Application

Page 1 of 2

Summarize other employment related to this job:

EDUCATION
Institution name
High school
College/university
Business/technical
Additional

Years
completed
3

Sanger High School

Field of study

Graduate or degree

general education

MILITARY
Are you a veteran?
Duty/specialized training:

Yes

X No

SKILLS & QUALIFICATIONS


Other qualifications such as special skills, abilities or honors that should be considered:
Types of computers, software, and other equipment you are qualified to operate or repair:
Professional licenses, certifications or registrations:
Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring
to the employers attention:
Typing speed:

45

per minute

REFERENCES
List two personal references who are not relatives or former supervisors.
Shannon Dietz
Name

Address

Telephone

biology teacher
Occupation

Address

Telephone

social science teacher


Occupation

Kendall Tacchino

Name

Years known
3
Years known

CONTACT
In case of accident or illness, please contact: Name:
Address:
1638 Tucker ave.

Macrina Hernandez

Daytime phone: (559)-618-0123


Relationship:
mother

INFORMATION TO THE APPLICANT


As part of our procedure for processing your employment application, your personal and employment references may be checked. If you
have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may
make a written request for information derived from the checking of your references.
If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United
States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and
agree to the information shown above.
3/28/2016
Aviud meza

Signature of Applicant

Date

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to
provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional
and failure to provide it will have no affect on your application for employment.
Developed at employer request by the Alaska Department of Labor & Workforce Development, Employment Security Division.
Rev. 8/2010

Employment Application

Page 2 of 2

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