Employment
Application
COMPANY OR EMPLOYER NAME:
Position applying for:
EMPLOYEE INFORMATION
Name:
aviud
meza
Last
Telephone: (619) 345-7805
Address:
First
Middle
Alternate telephone:
Email: aviudemeza@yahoo.com
1638 Tucker ave.
Are you able to perform the essential functions of
the position with or without accommodations?
Yes
No
If necessary for the job are you older than:
14
15
16
18
X 19
21
(Check one)
If necessary for the job, I am able to:
Work overtime?
X Yes
Yes
Provide a valid Alaska Driver's License?
If so, fill out the following:
Issuing state:
Type:
Endorsement(s):
I am legally eligible for employment in the U.S.?
X Yes
No
I am seeking a permanent position:
Yes X No
Hazardous Material
No
X No
Passengers
Tankers
Tank with Hazardous Materials
School Bus
Double/Triple trailers
Work the following shifts: (check all that apply)
I will be able to report to work
3 days after being notified I am hired.
X Any
Split
Day
Night
Graveyard
Swing
Rotating
Other:
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.
Employer name and address:
Position title/duties, skills:
Start date:
End date:
Reason for leaving:
Pay: $
Per:
Employer name and address:
Supervisor:
Position title/duties, skills:
Telephone:
Start date:
End date:
Reason for leaving:
Pay: $
Per:
Employer name and address:
Supervisor:
Position title/duties, skills:
Telephone:
Start date:
End date:
Reason for leaving:
Pay: $
Per:
Employer name and address:
Supervisor:
Position title/duties, skills:
Telephone:
Start date:
End date:
Reason for leaving:
Pay:
Per:
Rev. 8/2010
Supervisor:
Telephone:
Employment Application
Page 1 of 2
Summarize other employment related to this job:
EDUCATION
Institution name
High school
College/university
Business/technical
Additional
Years
completed
3
Sanger High School
Field of study
Graduate or degree
general education
MILITARY
Are you a veteran?
Duty/specialized training:
Yes
X No
SKILLS & QUALIFICATIONS
Other qualifications such as special skills, abilities or honors that should be considered:
Types of computers, software, and other equipment you are qualified to operate or repair:
Professional licenses, certifications or registrations:
Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring
to the employers attention:
Typing speed:
45
per minute
REFERENCES
List two personal references who are not relatives or former supervisors.
Shannon Dietz
Name
Address
Telephone
biology teacher
Occupation
Address
Telephone
social science teacher
Occupation
Kendall Tacchino
Name
Years known
3
Years known
CONTACT
In case of accident or illness, please contact: Name:
Address:
1638 Tucker ave.
Macrina Hernandez
Daytime phone: (559)-618-0123
Relationship:
mother
INFORMATION TO THE APPLICANT
As part of our procedure for processing your employment application, your personal and employment references may be checked. If you
have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may
make a written request for information derived from the checking of your references.
If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United
States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and
agree to the information shown above.
3/28/2016
Aviud meza
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
