Print, practice filling out this job application form, and use it as a guide when completing applications for

employment.
Then, review more job applications and information on applying for jobs.

Job Application Form

Instructions: Print clearly in black or blue ink. Answer all questions. Sign and date the form.
PERSONAL INFORMATION:
First Name ______Luiz_________________
Middle Name ________Tremillo________________
Last Name ____________Hernandez_________________
Street Address
________________520 Mallard Road_______________________________________
City, State, Zip Code
________Winfield, Alabama______35594_________________________________________
Phone Number
(250)___________________________________
Are you eligible to work in the United States?
Yes ____X___ No_______
If you are under age 18, do you have an employment/age certificate?
Yes _X__ No ___
Have you been convicted of or pleaded no contest to a felony within the last five years?
Yes_______ No __X_____
If yes, please explain: _________________________________________
__________________________________________________________
POSITION/AVAILABILITY:
Position Applied For
_____Computer hardware engineer___________________________________
Days/Hours Available
Monday __X__
Tuesday _X___
Wednesday __X__
Thursday _X___
Friday ___X_
Saturday __X__
Sunday __X__

Hours Available: from ____9 am___ to ___7 pm___

What date are you available to start work?
_________Any time_______________________________
EDUCATION:
Name and Address of School - Degree/Diploma - Graduation Date
____Winfield City High School_232 Pirate Cove ______May 23, 2014_____________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Skills and Qualifications: Licenses, Skills, Training, Awards
__Typing, managing ____________________________________________
_____________________________________________________________
EMPLOYMENT HISTORY:
Present Or Last Position:
Employer: __Zeferino Hernandez_____________________
Address: _________1520 Temple Ave N, Fayette, AL 35555_____
Supervisor: ___________ Zeferino Hernandez ________________________
Phone: _____ (205) 904-9721______________
Email: ________________________________
Position Title: _______Cashier__________
From: _____11 am_______ To: _____2 pm______
Responsibilities: ____________________________________________________
__________________________________________________________
Salary: __$6.25_an hour_______
Reason for Leaving: ____________Looking for a fresh start._____________________
===========
Previous Position:
Employer: _____________________________________________________

Address: ______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________
Email: ________________________________
Position Title: _________________________
From: ______________ To : ______________
Responsibilities: ___________________________________________________
__________________________________________________________
Salary: _______________
Reason for Leaving: ____________________________________________
May We Contact Your Present Employer?
Yes _X_ No _____
References:
Name/Title Address Phone
____ Zeferino Hernandez _____(205)-_______________________________________
_________________________________________________________________
_________________________________________________________________
I certify that information contained in this application is true and complete. I understand that false information may
be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I
authorize the verification of any or all information listed above.
Signature______________________________
Date____4/16/14______________________________