21THINGS4STUDENTS

Employment Application

APPLICANT INFORMATION
Last Name

Melekunnil-Raju

Street
Address

Dat
e
Apartment/Unit
#

First

Rosh

M.I.

State

Michigan

ZIP

Anthony Dr. 4069

City

Sterling Hieghts

Phone

858-487-3273

Date
Any time
Available
Position Applied
Doctor
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
4352
No.

48310

rrmelekunnil@gmail.com
Desired
Wage:

YES

NO

If no, are you authorized to work in the

U.S.?

YES

NO

If so, when?

YES

NO

If yes,
explain

Negotiable

YES

EDUCATION (PLEASE LIST MOST RECENT FIRST)

School 1

Grissom Middle School

Addres
s

23897

From

8t
h

YES

NO

To

9th

Did you
graduate?

School 2
From

Addres
s
9t
h

To

10th

Did you
graduate?

NO

Addres
s

School 3
From

YES

1
0t

To

12th

Did you
graduate?

YES

10/6/15

NO

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

Dr. Abraham

Relationshi
p

Company

The Doctors Office

Phone

Address

81263 Moountain Rd.

Full Name

Dr. Bessy

Relationshi
p

Company

The Doctors Office

Phone

Address

81263 Moountain Rd.

Full Name

Dr. Neil

Relationshi
p

Company

The Doctors Office

Phone

Address

81263 Moountain Rd.

yes

123-685-9250

yes

349-245-3453

yes

586-575-1234

NO

81263 Moountain Rd.

PREVIOUS EMPLOYMENT
Company

Seven Eleven

Phone

Address

56956

Superviso
r

Job Title

Register

Starting
Salary

858-487-3273

Ending
Salary

$7

Responsibilities

Have to get all the money from the costumers when they buy a product

From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?
Company

$10

Not enough money

YES

N/A

NO
Phone
Superviso
r

Address
Starting
Salary

Job Title

Ending
Salary

Ending
Salary

Responsibilities
From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?
Company

YES

N/A

NO
Phone
Superviso
r

Address
Starting
Salary

Job Title

Responsibilities
From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?

MILITARY SERVICE

YES

NO

N/A

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

Rosh Raju

Date

10/25/15