APPLICATION FOR EMPLOYMENT
(Pre-Employment Questionaire-An Equal Opportunity Employer)
Personal Information Date 3/8/2024
Name Watson Aviana M
Last First M.I.
Present Address 2275 Burt Street Omaha NE 68178
Street City State Zip
Permanent Address 629 16th Street Windom MN 56101
Street City State Zip
Cell Number 5078228198 Email avianamwatson@gmail.com
Are you either a U.S. Citizen or an Alien authorized to work in the United States (check one)?
X
_____YES _____NO
Date of Birth *
03/04/2005
Have you ever been convicted of a felony or a misdemeanor within the last 5 years? If yes, please describe below. **
* The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 10 but less than 70 years of age.
** You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.
Employment Desired
Position Waitress Date Available 5/13/24 Salary Desired $10
Summer/part-time help, last day of work 7/15/24 Work Labor Day Weekend? yes
Are you employed now? yes If so, may we contact them? yes
Have you applied to this company before? yes Where? Snappers When? 4/23
Education
NAME AND LOCATION # YRS ATTENDED DID YOU GRADUATE? SUBJECTS STUDIED
Winfair Elementary Windom MN 4
Grammar yes all
School
High Windom Area High School 9 yes all
School
Creighton University 1 currently enrolled psychology
College
Trade
School
General
Subjects of Special Study or Research Work
US Military or Naval Service Rank
Present Rank in National Guard or Reserve
Former Employers (List below, the last three employers, starting with the last one first)
Date Name and Address of Employer Salary Position Reason for leaving
(mm/yy)
From 01/21
Engaged
To now
HomeCare 629 16th Street Windom
$15 MNCaregiver I want to make extra cash
From 01/20
Decades
To 7//23
Boutique 1012 5th Ave Windom
Buyer,
$10MNModel, Sales AssociateCollege
From
To
References (Give the names of three persons not related to you, whom you have known at least one year)
Years
Name Address and Phone Business Acquinted
1.
Tierra West 2275 Burt Street 3087650322 College 1
2.
Lauren Hebert 2275 Burt Street 4025077956 Cut Co 1
3.
Personal Information
DO YOU HAVE ANY PHYSICAL LIMITATIONS THAT PRECLUDE YOU FROM PREFORMING ANY WORK FOR WHICH YOU ARE BEING CONSIDERED? ✔
If yes, what can be done to accommodate your limitation?
HAVE YOU EVER HAD ANY BACK PROBLEMS?
Please describe
In case of Emergency, notify: Ashley Johnson 629 16th Street Windom
5078220764
MNMother
Name Address Phone Relationship
"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF
EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS
CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY
PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR DAMAGE THAT MAY RESULT
FROM FURNISHING SHAME TO YOU. I UNDERSRTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINATE PERIOD AND MAY, REGARDLESS
OF THE DATE OF MY PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE."
SIGNATURE Aviana Watson DATE 3/8/2024
DO NOT WRITE BELOW THIS LINE
Interviewed by Date
Notes
Hired Salary Department
Position Start Date
APPROVED BY:
