EMPLOYMENT APPLICATION Employment Application Application Information *Last Name: *First Name: M.I.: *Address: *City: *State/Province: *Zip/Postal: *Island: Blakely Brown Charles Crane Lopez Obstruction Orcas San Juan Shaw Yellow Other *Phone: Formats: 360-378-5884 or 3603785884 *Email: *Date Available: Position Applied For: *Are you a citizen of the United States? Yes No If no, are you authorized to work in the U.S.? Yes No *Have you ever worked for this company? Yes No If so, when? *Have you ever been convicted of a felony? Yes No If yes, explain: Education High School: Address: From: To: Did you graduate? Yes No Diploma: College: Address: From: To: Did you graduate? Yes No Degree: Other: Address: From: To: Did you graduate? Yes No Degree: References Please list three professional references. Full Name: Relationship: Company: Phone: Address: Full Name: Relationship: Company: Phone: Address: Full Name: Relationship: Company: Phone: Address: Previous Employment Company: Phone: Address: Supervisor: Job Title: Responsibilities: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Company: Phone: Address: Supervisor: Job Title: Responsibilities: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Company: Phone: Address: Supervisor: Job Title: Responsibilities: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? Yes No 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. Signature: Date:
