Employment Application

Name:

COMPANY OR EMPLOYER NAME:

Soup`s Pizzeria and Grill

Position applying for: Cook / Dishwasher

EMPLOYEE INFORMATION
Last First Telephone: 641-381-0777 Email: 14aerickson@nkstudents.com Address:

Erickson

Annerena

Taletta
Middle Alternate telephone:

N/A

P. Sherman 42 Wallaby Way Sydney

If necessary for the job, I am able to: Work overtime? X Yes Yes Provide a valid Alaska Driver's License? If so, fill out the following: Issuing state: Type: N/A Endorsement(s):
Hazardous Material Tankers School Bus No No

Are you able to perform the essential functions of the position with or without accommodations?

Yes 14

No 15 19 No 16 21 (Check one)

No

If necessary for the job are you older than:

N/A
Passengers

X X

18 Yes

I am legally eligible for employment in the U.S.? I am seeking a permanent position:

Tank with Hazardous Materials Double/Triple trailers Swing Rotating

Yes

Work the following shifts: (check all that apply)

Any Split Day

I will be able to report to work Open days after being notified I am hired.

Night Other:

Graveyard

EMPLOYMENT HISTORY
List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.

Employer name and address:

Position title/duties, skills:

Start date:

End date:

Brian Campbell 834 Central Ave. Northwood Ia, 50459 Pay: $ 8.00 Per: 1 Hour

12-1-2013 Have not left

Head Cook
Supervisor: Brian Campbell Telephone: Position title/duties, skills: Reason for leaving:

Employer name and address:

555-555-5555

N/A - Just looking for another job.

Start date: End date:

Reason for leaving: Pay: $ Per: Employer name and address:

N/A

Supervisor: Position title/duties, skills:

Telephone: Start date: End date:

Reason for leaving: Pay: $ Per: Employer name and address:

N/A

Supervisor: Position title/duties, skills:

Telephone: Start date: End date:

Reason for leaving: Pay: Per: $

N/A
Supervisor: Telephone:
Employment Application Page 1 of 2

Rev. 8/2010

Summarize other employment related to this job:

N/A
EDUCATION
Institution name High school College/university Business/technical Additional Years completed Field of study Graduate or degree

Northwood-Kensett N/A N/A N/A

Yes

09-14

General

High school Diploma 14

MILITARY
Are you a veteran? Duty/specialized training:

X No SKILLS & QUALIFICATIONS

N/A

Other qualifications such as special skills, abilities or honors that should be considered: Types of computers, software, and other equipment you are qualified to operate or repair: Professional licenses, certifications or registrations:

N/A

N/A

N/A
Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employers attention:

3 years of Spanish, taken in high school. Typing speed: 53 per minute REFERENCES
List two personal references who are not relatives or former supervisors.

Deb Dakken
Name Name

Rainbow Ave. Utah.

Address Address

132-345-1029
Telephone Telephone

Occupation Occupation

Teacher

Years known Years known

N/A

Brian Campbell

Pizza Lane. Denver Co. 234-456-7868

CONTACT

Teacher / Boss

N/A

In case of accident or illness, please contact: Name: Address: 311 Peacock Ave, Springfield IL.

Kim Erickson

Daytime phone: Relationship:

236-769-0091 Mother

INFORMATION TO THE APPLICANT

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above.

Signature of Applicant

Annerena Erickson

Date

2-7-2014

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment. Developed at employer request by the Alaska Department of Labor & Workforce Development, Employment Security Division. Rev. 8/2010 Employment Application Page 2 of 2