Information

Full Name: wilson lauren n Date: 10/10/17

Last First M.I.
Address: 3596 Janney Ln
Street Address Apartment/Unit #
Va 24018
City State ZIP Code
Phone: (540) 793-7773 E-mail Address: heathersia@gmail.com

Date Available: 10/11 Social Security No.: 123-45-6789 Desired Salary: $10,000

Position Applied for: waitress

YES NO YES NO
Are you a citizen of the United States? yes If no, are you authorized to work in the U.S.?
NO
YES n
Have you ever worked for this company? o If yes, when?
YES NO
Have you ever been convicted of a felony? no

If yes, explain:

Education
High School: Cave spring high Address:
YES NO
From: To: Did you graduate? no Degree:

College: Address:
YES NO
From: To: Did you graduate? no Degree:

Other: Address:
YES NO
From: To: Did you graduate? Degree:

References
Please list three professional references.

Full Name: Meredith Shuman Relationship: Teacher

Company: Cave spring high Phone: (540)

Address: Cave spring High

Full Name: Cait Moorman Relationship: Current boss

Company: Macados Phone: (540)

Address: Macados

Full Name: Jen smith Relationship: Current manager

Company: Macados Phone: (540)

Address: Macados
Previous Employment
Company: Phone: ()

Address: Supervisor:

Job Title: Starting Salary: $ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

YES NO
May we contact your previous supervisor for a reference?

Company: Phone: ()

Address: Supervisor:

Job Title: Starting Salary: $ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

YES NO
May we contact your previous supervisor for a reference?

Company: Phone: ()

Address: Supervisor:

Job Title: Starting Salary: $ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

YES NO
May we contact your previous supervisor for a reference?

Military Service
Branch: From: To:

Rank at Discharge: 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.

Lauren wilson