SAGE INTERIOR DESIGN

Employment Application

APPLICANT INFORMATION
Last Name

DAmato

Street
Address

First

Dat
e
Apartment/Unit
#

Judith

M.I. G

305 Elm Street

City

Clarksburg

State

Phone

304-672-1958

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

WV

ZIP

E-mail
GracieDamato@gmail.com
Address
Social Security
Desired
546-65-6573
No.
Salary

YES

NO

If no, are you authorized to work in the

U.S.?

YES

NO

If so, when?

N/A

YES

NO

If yes,
explain

N/A

Addres
s

One Eagle Way Clarksburg, WV 26301

YES

NO

Addres
s

N/A

YES

NO

Addres
s

N/A

YES

NO

Robert C Byrd High School

From

2014

Colleg
e

N/A

From

N/A

Other

N/A

From

N/A

To

To

To

2017

N/A

N/A

Did you
graduate?

Did you
graduate?

Did you
graduate?

Degree

General Diploma

Degree

N/A

Degree

N/A

REFERENCES
Please list three professional references.
Full Name

Mrs. Becky Hurst

Relationshi
p

Company

Nutter Fort Elementary

Phone

Address

345 Clark Ave Bridgeport, WV 26330

Full Name

Mr. Joe Growl

Relationshi
p

Company

Robert C. Byrd High School

Phone

Address

567 Deer Drive Elkins, WV 26421

Full Name

Dr. Geraldine Beckett

Relationshi
p

Company

Robert C. Byrd

Phone

Address

162 Crummit Lane Clarksburg, WV 26301

Teacher

304-657-8753

Principal

304-423-5734

Teacher

304-623-2200

N/A

26301

EDUCATION
High
School

12/15/15

Open

YES

NO

PREVIOUS EMPLOYMENT
Company

Altered Productions Institute for the Creative Arts

Phone

Address

201 W. Pike Street

Superviso
r

Job Title

Tumbling Assistant

Responsibilities

Starting
Salary

2014

Company

$5 an hour

To

YES

$5 an hour

Ending
Salary

N/A

Ending
Salary

N/A

NO
Phone

Address

N/A

Superviso
r

Job Title

N/A

Starting
Salary

Responsibilities

N/A

From

To

N/A

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

NO
Phone

Address

N/A

Superviso
r

Job Title

N/A

Starting
Salary
N/A

From

To

N/A

Reason for Leaving

May we contact your previous supervisor for a

reference?

N/A

N/A

N/A

Responsibilities

N/A

N/A

Company

N/A

Ending
Salary

N/A

N/A

N/A

Mr. Joe Yeager

Teach Classes Wednesdays and Thursdays

Curren
Reason for Leaving
t
May we contact your previous supervisor for a
reference?
From

304-624-0900

N/A
N/A

N/A

N/A
YES

NO

MILITARY SERVICE
Branch

N/A

Rank at Discharge

From
N/A

If other than honorable,

explain

N/A

To

N/A

Type of Discharge

N/A

N/A

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

12/15/15