21THINGS4STUDENTS

Employment Application

APPLICANT INFORMATION
Last Name
Street
Address

Monroe

Dat
e
Apartment/Unit
#

First

Lindsey

M.I. N

State

TX

ZIP

P.O Box 221

City

Claude

Phone

806-226-3091

Date
1-26-15
Available
Position Applied
Babysitting
for
Are you a citizen of the United
States?
Have you ever worked for this
company?
Have you ever been convicted of a
felony?

12-18-00

79019

E-mail
Lindseynichole19@gmail.com
Address
Social Security
Desired
123-45-6789
No.
Wage:

YES

NO

If no, are you authorized to work in the

U.S.?

YES

NO

If so, when?

YES

NO

If yes,
explain

YES

EDUCATION (PLEASE LIST MOST RECENT FIRST)

School 1

Claude High School

Addres
s

509 Vine Claude, TX 79019

From

Jan
201
0

YES

NO

Crestview Elementary

Addres
s

80 Hunsley Road, Canyon, TX 79015

Aug
200

YES

NO

School 2
From

T
o

T
o

May
2019

Dec
2009

Did you
graduate?

Did you
graduate?

Addres
s

School 3
T
o

From

Did you
graduate?

YES

NO

REFERENCES
Please list three professional references you have known at least 3 years and are not friends or relatives.
Full Name

Jan Gunter

Relationshi
p

Company

First Baptist

Phone

Address

308 Parks St, Claude, Texas 79019, United States

Full Name

Jana Lemons

Relationshi
p

Company

Claude ISD

Phone

Address

509 Vine Claude, TX 79019

Full Name

Jay and Heather Morris

Relationshi
p

Company

Babysitting Job

Phone

Address

Employer

806-226-4811

Teacher

806-226-2191

Employer

NO

PREVIOUS EMPLOYMENT
Company

First Baptist Claude

Phone

Address

308 Parks St, Claude, Texas 79019, United States

Superviso
r

Job Title

Nursery Worker

Responsibilities

Starting
Salary

Jan Gunter

$ 53 per month

Ending
Salary

$53 per month

Ending
Salary

Ending
Salary

Watch kids during the church service

Sep
Prese
To
Reason for Leaving
2014
nt
May we contact your previous supervisor for a
reference?
From

YES

NO

Company

Phone

Address

Superviso
r
Starting
Salary

Job Title

Responsibilities
From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

NO

Company

Phone

Address

Superviso
r
Starting
Salary

Job Title

Responsibilities
From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

NO

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

Lindsey Monroe

Date
1-2715