Employment Application (Please Type Then Print out This Application to Submit at Your WRC

Work Readiness Certificate

Employment Application – (Please type then print out this application to submit at your WRC appointment) Applicant Information

Full Name: Date: Last First M.I. Address: Street Address Apartment/Unit #

City State ZIP Code Phone: ( ) E-mail Address:

Date Available: Social Security No.: XXX-XX-______Desired Salary: $

Position Applied for: YES NO YES NO Do you have the legal right to work in the U.S.? Can you provide written proof of this if hired? YES NO Have you ever worked for this company? If so, when? YES NO Have you ever been convicted of a felony? If yes, explain:

Education

High School: Address: YES NO M/Yr: To: Did you graduate? Degree:

College: Address: YES NO M/Yr: To: Did you graduate? Degree:

Other: Address: YES NO M/Yr: To: Did you graduate? Degree:

References Please list three professional references. How do you Full Name: know this person:

Business: Phone: ( )

Address: How do you Full Name: know this person:

Address: Previous Employment

Company: Phone: ( )

Address: Supervisor:

Job Title: Starting Salary: $ Ending Salary: $

Responsibilities:

M/Yr: To: Reason for Leaving: YES NO May we contact your previous supervisor for a reference?

Company: Phone: ( )

Responsibilities:

Company: Phone: ( )

Responsibilities:

Military Service

Branch: M/Yr: 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: Date: