Company Name

Employment Application
Applicant Information
Full Name: Rivera Snchez
Last

Address:

Roxanna

M.

First

M.I.

Date:November 16, 2014

Carr. 185 km 5.6 Bo. Campo Rico

Street Address

Phone:

Apartment/Unit #

Canvanas

PR

00729

City

State

ZIP Code

787-427-4428

Date Available:

Email roxannarivera7@gmail.com
Desired Salary:$

Social Security No.:

Position Applied for: Seasonal Sales Team Member

YES

NO

YES

Are you a citizen of the United States?

If no, are you authorized to work in the U.S.?

YES

NO

Have you ever worked for this company?

If yes, when?
YES

NO

Have you ever been convicted of a felony?

If yes, explain:

Education
High School:

Address:
YES

From:

To:

College:

Diploma::

Address:
YES

From:

To:

NO

Did you graduate?

Other:

Degree:

Address:
YES

From:

NO

Did you graduate?

To:

Did you graduate?

NO

Degree:

References
Please list three professional references.
Full Name:

Relationship:

Company:

Phone:

Address:
1

NO

Full Name:

Relationship:

Company:

Phone:

Address:
Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment
Company:

Phone:

Address:

Supervisor:
Starting Salary:$

Job Title:

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:

YES

NO

May we contact your previous supervisor for a reference?

Company:

Phone:

Address:

Supervisor:
Starting Salary:$

Job Title:

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:

YES

NO

May we contact your previous supervisor for a reference?

Company:

Phone:

Address:

Supervisor:
Starting Salary:$

Job Title:

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:

YES

May we contact your previous supervisor for a reference?

NO

Military Service
Branch:

From:

Rank at Discharge:

To:

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:

Roxanna M. Rivera Snchez

Date:16/11/2014