Information

Full Name: Lawrence Lexi M Date: 10/10/17

Last First M.I.
Address: 5430 Clearwood Dr.
Street Address Apartment/Unit #
Roanoke VA 24014
City State ZIP Code
Phone: (540) 759-1432 E-mail Address: lexilawrence03@gmail.com

Date Available: ASAP Social Security No.: 123-45-6789 Desired Salary: $N/A

Position Applied for: Infirmary Registered Nurse

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

If yes, explain:

Education

High School: Cave Spring High School Address: 3712 Chaparral Dr

YES NO
From: 2014 To: 2018 Did you graduate? Degree: Advanced Studies Diploma

College: Virginia Western Community College Address: 3095 Colonial Ave

YES NO
From: 2018 To: 2019 Did you graduate? Degree: Associates

Other: Jefferson College of Health Sciences Address: 101 Elm Ave

YES NO
From: 2019 To: 2023 Did you graduate? Degree: RN-BSN Bachelors

References
Please list three professional references.

Full Name: Timothy Smith (TJ) Relationship: Supervisor

Company: Rainwater Management Solutions Phone: (540) 123-4567

Address: 1234 Barkley D.

Full Name: Shawn Crawford Relationship: Supervisor

Company: Rainwater Management Solutions Phone: (540) 123-4567

Address: 1234 Barkley Ln.

Full Name: Chrystal Shawn Relationship: Teacher

Company: Cave Spring High School Phone: (540) 123-4567

Address: 1234 Barkley Ave.

Previous Employment
Company: Rainwater Management Solutions Phone: (540) 123-4567

Address: Riverside Dr. Supervisor: Shawn Crawford

Job Title: Office Manager Starting Salary: $10.00 Ending Salary: $10.00

Responsibilities: Phone calls, organization, computer work

From: August 2017 To: October 2017 Reason for Leaving: I wanted to challenge and advance myself
YES NO
May we contact your previous supervisor for a reference?

Company: Cave Spring High School Phone: (540) 123-4567

Address: Chaparral Dr. Supervisor: Chrystal Shawn

Job Title: Team Leader Starting Salary: $0 Ending Salary: $0

Responsibilities: Organize, interview, write

From: 2016 To: 2018 Reason for Leaving: I couldnt take the class anymore since I graduated
YES NO
May we contact your previous supervisor for a reference?

Company: Carilion Clinic Phone: (540) 123-4567

Address: 1234 Medical Dr. Supervisor: Casey Smith

Job Title: RN Specialist Starting Salary: $15 Ending Salary: $20

Responsibilities: Taking care of patients

From: 2023 To: Current Reason for Leaving: I am still working there currently
YES NO
May we contact your previous supervisor for a reference?

Military Service
Branch: No military service 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.

Lexi Lawrence 10/10/17