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Peninsula College

Employment Application | Model


Applicant Information
Full Name: Mudd Sabrina A Date: Feb. 13, 2018
Last First M.I.

Address: 1515 East Mesa View Lane


Street Address Apartment/Unit #

Port Angeles WA 98362


City State ZIP Code

Phone: (360) 860-1622 Email salaga00@yahoo.com

Date Available: 03/01/2018 Social Security No.: 123-45-6789 Desired Salary:$ 16.00 ph

Position Applied for: Administrative Assistant

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: Forks Jr/Sr High Address: 261 Spartan Ave., Forks,WA 98331

YES NO
From: 1984 To: 1986 Did you graduate? Diploma:: GED

College: Peninsula College Address: 1502 East Lauridsen Blvd. , Port Angeles,WA 98362

YES NO
From: Sept. 2016 To: June 2018 Did you graduate? Degree: AAS Medical Specialization

Other: Address:

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

References
Please list three professional references.

Full Name: Scott Metzler Relationship: Supervisor


Company: Safeway Phone: (360) 457-1461

1
Address: 2709 East Hwy. 101, Port Angeles,WA 98362

Full Name: Randi Ackerman Relationship: Supervisor


Company: Albertson's Phone: (360) 297-1800
Address: 8196 SR Hwy. 104, Kingston,WA 98364

Full Name: Cathy Van Os Relationship: Supervisor


Company: Robert Witham,MD Phone: (360) 452-5322
Address: 224 North Washington St., Port Angeles,WA 98362

Previous Employment
Company: Robert Witham,MD Phone: (360) 452-5322
Address: 224 North Washington St., Port Angeles, WA 98362 Supervisor: Cathy Van Os

Job Title: Office Assistant Starting Salary:$ 12.00 ph Ending Salary:$ 14.00 ph

Responsibilities: Customer service, Maintaining paper and electronic charts, answering phones, taking messages, general office duties

From: Jan.,2017 To: Present Reason for Leaving: Seeking full time employment

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

Company: Haggen Food's Phone: (360) 457-1461


Address: 114 East Lauridsen Blvd., Port Angeles, WA 98362 Supervisor: Scott Metzler

Job Title: General Merchandise Manager Starting Salary:$ 20.48 ph Ending Salary:$ 20.48 ph

Responsibilities: Ordering,stocking, merchandising and receiving product, customer service, inventory, Microsoft Office

From: Feb. 2015 To: May 2016 Reason for Leaving: Store Closed

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

Company: Albertson's Phone: (360) 457-1461


Address: 114 East Lauridsen Blvd., Port Angeles, WA 98362 Supervisor: Scott Metzler

Job Title: General Merchandise Manager Starting Salary:$ 20.48 Ending Salary:$ 20.48

Responsibilities: Non-Foods manager responsible for ordering,stocking,merchandising,receiving,inventory, customer service

From: Aug. 2011 To: Feb. 2015 Reason for Leaving: Store Sold to Haggen's

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

2
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.

Signature: Sabrina Mudd Date: February 18, 2018

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