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Job Application

Employment Application
Applicant Information
Full Name: Ho Vickey Date: MM/DD/YY
Last First M.I.

Address: 13401 Sheppard Cir Apt B


Street Address Apartment/Unit #

Garden Grove CA 92844


City State ZIP Code

Phone: 714-603-4820 Email vickeyho23@gmail.com

Date Available: MM/DD/YY Social Security No.: XXX-XXX-3550 Desired Salary:$11.00

Position Applied for: N/A

YES NO YES NO
Are you a citizen of the United States? ☐X ☐ If no, are you authorized to work in the U.S.? ☐ ☐

YES NO
Have you ever worked for this company? ☐ ☐X If yes, when?

YES NO
Have you ever been convicted of a felony? ☐ ☐X

If yes, explain:

Education
High School: Westminster High School Address:14325 Goldenwest St. Westminster, CA 92683

August YES NO
From: 2014 To: June 2018 Did you graduate? ☐ ☐X Diploma::

College: UC Santa Barbara Address:Santa Barbara, CA 93106

YES NO
From: To: Did you graduate? ☐ ☐X Degree:

Other: Address:

YES NO
From: To: Did you graduate? ☐ ☐ Degree:

References
Please list three professional references.

Full Name: Relationship:


Company: Phone:

1
Address:

Full Name: Relationship:


Company: Phone:
Address:

Full Name: Relationship:


Company: Phone:
Address:

Previous Employment
Company: Phone:
Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

YES NO
May we contact your previous supervisor for a reference? ☐ ☐

Company: Phone:
Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

YES NO
May we contact your previous supervisor for a reference? ☐ ☐

Company: Phone:
Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

2
YES NO
May we contact your previous supervisor for a reference? ☐ ☐

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:

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