21THINGS4STUDENTS

Employment Application

APPLICANT INFORMATION
Last Name

Chrisman

Street
Address

Dat
e
Apartment/Unit
#

First

Madison

M.I. A

State

Michigan

ZIP

3375 E. Hatton road

City

Harrison

Phone

1989-444-8275

Date
June 4th
Available
Position Applied
for
Are you a citizen of the United
States?
Have you ever worked for this
company?
Have you ever been convicted of a
felony?

E-mail
Address
Social Security
No.

5/1/15

48625

Mchrisma20hcs@stu.harrisonschools.com
Desired
Wage:

YES x

NO

If no, are you authorized to work in the

U.S.?

YES

NO x

If so, when?

YES

NO x

If yes,
explain

Min

YES x

EDUCATION (PLEASE LIST MOST RECENT FIRST)

School 1

Harrison Middle School

Addres
s

710 S. 5th street, Harrison MI

From

2
0

YES

NO x

To

2015

Did you
graduate?

School 2

Addres
s

From

To

Did you
graduate?

YES

NO

Addres
s

School 3
From

To

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

Chelsea Lugo

Relationshi
p

Company

Harrison athletics

Phone

Full Name

Jennifer Whitaker

Relationshi
p

Company

Harrison athletics

Phone

Full Name

Karen Hubble

Relationshi
p

Company

Ks Diner, The Mad caf

Phone

Cheer Coach

Address
Cheer coach 2

Address

Address

Previous Boss

NO

PREVIOUS EMPLOYMENT
Company

Chrisman Heating and cooling

Phone

Address

3375 E. Hatton rd.

Superviso
r

Job Title

Employer

Responsibilities

Starting
Salary

2013

Chrismans Country Caf

Address

3375 E Hatton road

Job Title

Wash dishes ,bust tables

2010

Company

YES x

Starting
Salary

YES x

Ks Diner

Wash Dishes and bust tables, clean

Responsibilities

Phone
19895064727
Superviso
Shannon Chrisman
r
$ 14 dollars an
Ending
hour
Salary

$ 20 dollars an hour

NO
Phone

Starting
Salary

Superviso
Karen Hubble
r
$13 dollars an
Ending
hour
Salary

$14 dollars an hour

Make sure everythings clean for customers

To
Reason for Leaving
2015
May we contact your previous supervisor for a
reference?
From

NO

To
2013

Address
Job Title

$13 dollars an hour

Make sure dishes and tables are clean for the next customers

Reason for Leaving

Restaurant shut
down
May we contact your previous supervisor for a
reference?
From

Ending
Salary

$10 an hour

To

Company

Responsibilities

Tom Chrisman

Fixing machines and working them

Reason for Leaving

School
May we contact your previous supervisor for a
reference?
From

1989-506-3202

2013

School started
YES x

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

Date