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Employment Application
Name: Tenold Last Telephone: 641-390-1234 Address:
Tiarra
Dishwasher
EMPLOYEE INFORMATION
Justine
641-324-1822
Are you able to perform the essential functions of the position with or without accommodations?
x Yes
No 15 19 No 16 21 (Check one)
If necessary for the job, I am able to: x Yes Work overtime? Yes Provide a valid Alaska Driver's License? If so, fill out the following: Issuing state: Type: Endorsement(s):
Hazardous Material Tankers School Bus No Any Split
No x No
Passengers
x Yes
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. Tiarra Tenold
Start date:
11/9/12
End date:
Present
Rev. 8/2010
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Summarize other employment related to this job:
EDUCATION
Institution name High school College/university Business/technical Additional
Northwood-Kensett N/A N/A N/A
Years completed
12 N/A N/A N/A
Field of study
N/A N/A N/A N/A
Graduate or degree
Graduate N/A N/A N/A
MILITARY
Are you a veteran? Duty/specialized training: Yes No
Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employers attention:
N/A
Typing speed:
N/A
per minute
REFERENCES
List two personal references who are not relatives or former supervisors.
Kelsey Katcher Name Zoie Stapelkamp Name 800 2nd Street W Address 101 18th Street N Address 641-390-1220 Telephone 641-324-1015 Telephone Waitress Occupation Hostess Occupation 16 Years known 9 Years known
CONTACT
In case of accident or illness, please contact: Name: 200 3rd Street W Address:
Suzie Reyerson
641-390-1222 Mother
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