Peninsula College

Employment Application | Model

Applicant Information
Full Name: Wood
Last

Tamee

First

M.I.

Date:02/18/2015

274 Avis Street

Address:

Street Address

Apartment/Unit #

Port Angeles

WA

98362

City

State

ZIP Code

360-912-4309

Phone:

Date Available: 03/01/2015

EmailTjarvis91@hotmail.com
Social Security No.:***-**-***

Desired Salary:negotiable

Position Applied for: Student Services Front Desk

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:

Port Angeles High School

Address:304 East Park Avenue Port Angeles, WA 98362

YES

From:

09/2005

To:06/2009

Diploma::High School Diploma

1502 East Lauridsen Boulevard Port Angeles, WA

Address:98362

College: Peninsula College

YES

From:

09/2009

To:06/2015

NO

Degree:Will Graduate 06/2015

Did you graduate?

Other:

Address:
YES

From:

NO

Did you graduate?

To:

Did you graduate?

NO

Degree:

References
Please list three professional references.
Full Name: Debi Menichini Barlow

Relationship:Professor

NO

Company:

Peninsula College

Phone:360-452-9277

Address:

1502 East Lauridsen Boulevard Port Angeles, WA 98362

Full Name: Kate Parker

Relationship:Co-Worker

Company:

St. Andrews Place

Phone:360-912-4181

Address:

520 East Park Avenue Port Angeles, WA 98362

Full Name: Kimberley Flores

Relationship:Co-Worker

Company:

St. Andrews Place

Phone:360-417-3418

Address:

520 East Park Avenue Port Angeles, WA 98362

Previous Employment
Company:

St. Andrews Place

Phone:360-417-3418

Address:

520 East Park Avenue Port Angeles, WA 98362

Job Title:

Personal Service Assistant

Supervisor:Jamie Rusnak

$12.00 per
Starting Salary:hour

Ending Salary:$still employed

Assist residents with day to day activities, Serve meals, Report any changes in condition to
Responsibilities: med tech or nurse
From:

01/2015

To:Present

Reason for Leaving:Not Applicable

YES

NO

May we contact your previous supervisor for a reference?

Company:

Korean Womens Association

Address:

616 East Front Street

Job Title:

Certified Nursing Assistant

Phone:360-452-2119
Supervisor:Melinda Bishop
Starting Salary:$11.84

Ending Salary:$11.84

Assisted clients with daily living activities, Followed care plan, and Coordinated daily living
Responsibilities: with family.
From:

05/2013

To:12/2014

Reason for Leaving:Was not able to get enough hours.

YES

NO

May we contact your previous supervisor for a reference?

Company:

RS Schmidt Janitorial

Phone:360-452-9567

Address:

93 North Maple Lane Port Angeles, WA 98362

Job Title:

Janitor

Starting Salary:$10.00

Supervisor:Leah Striebeck
Ending Salary:$11.00

Responsibilities: Cleaned, sanitized, and restocked local banks and doctor offices.
From:

07/2013

To:01/2015

Reason for Leaving:Scheduling Conflicts

2

YES

NO

May we contact your previous supervisor for a reference?

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.
Date:03/03/2015

Signature: