APPLICATION FOR EMPLOYMENT
This generic application is provided by WorkSource Washington. This form complies with federal and state laws against discrimination; however, employers using this form should check local ordinances. WorkSource Washington and Washington State Employment Security are not responsible for the misuse of information provided on this form. Provide all information re uested by printing in ink or typing. !se the "T#$" key to move through the document.
GENERAL INFORMATION
Name (Last) %iguel Address (Mailing Address) (First) (Middle Initial) Home Telephone
Edith
(City) ( tate) (!ip)
5222. 4
&'()* 387 + 0479
Other Telephone
,-. S /ormandie #ve #pt0121
E"Mail Address
3os #ngeles
&* + 8es /o
edithmiguel.26yahoo.com
#re you legally entitled to work in the !.S.7 &ill A''ept( Part+Time 9ull+Time Temporary
%ate A)aila*le
#O ITION
#osition Or Type O$ Employment %esired
$aker or 4ahsier
#re you able to perform the essential functions of the =ob you are applying for, with or without reasonable accommodation7 8es /o
alary %esired
hi$t( :ay Swing ;raveyard <otating
>)..22
#ny Time
.es No
E%+CATION AN% TRAINING
High 'hool Grad,ate Or General Ed,'ation (GE%) Test #assed?f no, list the highest grade completed ('
College/ 0,siness 'hool/ Military (Most re'ent $irst)
/ame and 3ocation :ates #ttended %onth@8ear 4redits Earned Buarterly or Dther Semester &Specify* Cours ;raduate :egree A 8ear %a=or or Sub=ect
E1piration %ate
9rom To 9rom To 9rom To 9rom To
N,m*er
8es /o 8es /o 8es /o 8es /o
&here Iss,ed &here Iss,ed
O'',pational Li'ense/ Certi$i'ate or Registration O'',pational Li'ense/ Certi$i'ate or Registration
N,m*er
E1piration %ate
O'',pational Li'ense/ Certi$i'ate or Registration
N,m*er
&here Iss,ed
E1piration %ate
Lang,ages Read/ &ritten or po2en Fl,ently Other Than English
3ETERAN INFORMATION (Most re'ent)
0ran'h o$ er)i'e %ate o$ Entry %ate o$ %is'harge
(Ma1im,m 6777 'hara'ters) ?"m
#ECIAL 4ILL (List all pertinent s2ills and e5,ipment that yo, 'an operate)
a hard working person that is willing to learn many new stuff that comes around me. ?"m also a fast learner
EMS 10171 CC 7540-032 635 ESD 1999 Rev. 12/30/03
&OR4 E8#ERIENCE (Most Re'ent First)
Employer Address ;o* Title pe'i$i' %,ties (Ma1im,m 6777 'hara'ters)
(In'l,de )ol,ntary 9or2 and military e1perien'e) Telephone N,m*er
Edgar 4aiEpanta ,2( S 4atalina St 3os #ngeles,4alifornia 4ashier
&'()* 460 + 4643 (
From (Month:.ear)
Dctober '2(To (Month:.ear)
N,m*er Employees ,per)ised
/ovemember '2(Ho,rs #er &ee2
While the Scholastic $ook fair came to my school i was put as a cashier at the last minute had no eFperience at all, but one guy from the Scholastic $ook fair taught me twice and i learned what to do already.
'
Last alary
>2
,per)isor
4aiEapanta
Reason For Lea)ing Employer Address ;o* Title pe'i$i' %,ties (Ma1im,m 6777 'hara'ters)
Scholastic $ook fair left
Telephone N,m*er
May &e Conta't This Employer-
8es
/o
&* +
From (Month:.ear)
To (Month:.ear)
N,m*er Employees ,per)ised
Ho,rs #er &ee2
Last alary
,per)isor
Reason For Lea)ing Employer Address ;o* Title pe'i$i' %,ties (Ma1im,m 6777 'hara'ters)
Telephone N,m*er
May &e Conta't This Employer-
8es
/o
&* +
From (Month:.ear)
To (Month:.ear)
N,m*er Employees ,per)ised
Ho,rs #er &ee2
Last alary
,per)isor
Reason For Lea)ing Employer Address ;o* Title pe'i$i' %,ties (Ma1im,m 6777 'hara'ters)
Telephone N,m*er
May &e Conta't This Employer-
8es
/o
&* +
From (Month:.ear)
To (Month:.ear)
N,m*er Employees ,per)ised
Ho,rs #er &ee2
Last alary
,per)isor
Reason For Lea)ing
May &e Conta't This Employer-
8es
/o
I 'erti$y the in$ormation 'ontained in this appli'ation is tr,e/ 'orre't/ and 'omplete< I ,nderstand that/ i$ employed/ $alse statements reported on this appli'ation may *e 'onsidered s,$$i'ient 'a,se $or dismissal<
ignat,re o$ Appli'ant========================================================= %ate================ ?nterviewerGs 4ommentsH
&or2 o,r'e &ashington and &ashington tate Employment e',rity are e5,al opport,nity employers and pro)iders o$ employment and training ser)i'es< A,1iliary aids and ser)i'es are a)aila*le to persons 9ith disa*ilities ,pon re5,est<
