Information
Full Name: Taylor Austin Z Date: 10/13/2017
Last First M.I.
Address: 9534 orchard Drive
Street Address Apartment/Unit #
Bent Mountain VA 24059
City State ZIP Code
Phone: (5402069931) E-mail Address: Jayndayz1@gmail.com
Date Available: 10/16 Social Security No.: 123-45-6789 Desired Salary: $8.00 per hour
Position Applied for: cashier
YES NO YES NO
Are you a citizen of the United States? Y If no, are you authorized to work in the U.S.?
YES NO
Have you ever worked for this company? N If yes, when?
YES NO
Have you ever been convicted of a felony? N
If yes, explain:
Education
High School: Cave spring high Address: 3712 Chaparral Dr
YES NO
From: 2014 To: 2018 Did you graduate? N Degree:
College: Address:
YES NO
From: To: Did you graduate? Degree:
Other: Address:
YES NO
From: To: Did you graduate? Degree:
References
Please list three professional references.
Full Name: Relationship: work
Company: Kmart store shut down Phone: (540) 9820995
Address: 3533 franklin road
Full Name: Relationship: work
Company: Walmart Phone: (540) 7723892
Address: 5350 clearbrook village Ln
Full Name: Relationship: work
Company: walgreens Phone: (540) 725 1546
Address: 4049 brambleton Ae
Previous Employment
Company: Kmart Phone: (540) 9820995
Address: 3533 franklin road Supervisor:
Job Title: cashier Starting Salary: $7.25 Ending Salary: $7.25
Responsibilities: Cashier
From: 4/3/2016 To: 8/4/2016 Reason for Leaving: Work conditions
YES NO
May we contact your previous supervisor for a reference? Y
Company: walmart Phone: (540) 7723892
Address: 5350 clearbrook village Supervisor:
Job Title: cashier Starting Salary: $9.00 Ending Salary: $10.00
Responsibilities: cashier
From: 12/3/16 To: 7/25/17 Reason for Leaving: Work conditions
YES NO
May we contact your previous supervisor for a reference?
Company: walgreens Phone: (540) 725 1546
Address: 4049 brambleton Ave Supervisor:
Job Title: cashier Starting Salary: $9.00 Ending Salary: 9.00
Responsibilities: cashier
From: 9/12/17 To: unknown Reason for Leaving: Unkown
YES NO
May we contact your previous supervisor for a reference? N
Military Service
Branch: From: 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.
