EMPLOYMENT / JOB APPLICATION
PERSONAL INFORMATION
FULL NAME: Tristan Drake Langley DATE: 9/28/2020
First Middle Last
ADDRESS: 171 Rolling Hills Drive _
Street Address Apt/Suite
Cartersville Georgia 30120 _
City State Zip Code
E-MAIL: tristanlangley2002@yahoo.com PHONE: (470) 348 - 9220
SOCIAL SECURITY NUMBER (SSN): 16-674-5311
DATE AVAILABLE: __9/28/2020________________ DESIRED PAY: $__20.00______ ☐
HOUR ☐ SALARY
POSITION APPLIED FOR: Fire Fighter _
EMPLOYMENT DESIRED: ☐ FULL-TIME ☐ PART-TIME ☐ SEASONAL
EMPLOYMENT ELIGIBILITY
ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO*
HAVE YOU EVER WORKED FOR THIS EMPLOYER? ☐ YES* ☐ NO
*IF YES, WRITE THE START AND END DATES: ____________________________________
HAVE YOU EVER BEEN CONVICTED OF A FELONY? ☐ YES* ☐ NO
*IF YES, PLEASE EXPLAIN: ____________________________________________________
EDUCATION
HIGH SCHOOL: Woodland Highschool CITY / STATE: Cartersville/Georgia
FROM: 2016 TO: 2020
GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________
BACKGROUND CHECK CONSENT
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IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? ☐ YES ☐ NO
DISCLAIMER
Applicant understands that this is an Equal Opportunity Employer and committed to excellence
through diversity. In order to ensure this application is acceptable, please print or type with the
application being fully completed in order for it to be considered.
Please complete each section EVEN IF you decide to attach a resume.
I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this
application leads to my eventual employment, I understand that any false or misleading
information in my application or interview may result in my employment being terminated.
SIGNATURE Tristan Langley DATE __9/28/2020___
PRINT NAME ___Tristan Langley______________________________
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