Employment Application

    1. Personal

    Name:

    Telephone:

    Email:

    Address:

    Are you 18 years of age or older?
    YesNo

    If no, please state your age:

    Have you ever been employed under another name?
    YesNo

    If yes, list the name:

    Do you possess a valid California Driver's License?
    YesNo

    CDL Number:

    Has your Driver's License ever been suspended or revoked?
    YesNo

    If yes, please explain:

    Nearest Living Relative - Name:
    Telephone Number:
    Relationship:

    Address:

    2. Position

    Title:
    Salary:
    Hours:
    Date of Employment:

    Name of Supervisor:

    3. Previous Employment

    Name & Address of Employer:
    Telephone Number:
    Job Title & Type of Work:
    Reason for Leaving:
    Dates From:
    To:

    4. Education

    Highest Year Completed:

    Diploma:

    Currently enrolled in high school completion course?
    YesNo
    If yes, give expected completion date:

    Employment - Related Education Courses
    Course Title:

    Name of school or organization address:
    Number units completed:

    Date completed:

    Currently enrolled:

    Name university, college, or
    business school address:
    Major subject:

    No. of years completed:

    No. of units completed:

    Diploma degree or certificate:
    Date completed:

    5. References


    List names of three persons who can give information about your background, character, abilities, etc.

    Name
    Address
    Phone
    Relationship

    6. Professional and Technical Qualifications

    A. List Licenses or Certifications of Competence held:

    B. Names of Professional Associates of which you are a member:

    Notes:

    I hereby certify under penalty that the above statements are true and correct. I give my permission for any necessary verification.

    Signature:

    Date: