SAGE INTERIOR DESIGN

Employment Application

APPLICANT INFORMATION
Last Name

Riestenberg

Street Address

First

Robert

M.I. CTE

Woodland Ave.

Apartment/Unit #

City

Stonewood

State

Phone

304-497-6691

E-mail Address

Date Available

Present

Position Applied for

Date

Social Security No.

WV

ZIP
riestenbergr@gmail.com

2344456

Desired Salary

Open

Supervisor
YES

NO

If no, are you authorized to work in the U.S.?

Have you ever worked for this company?

YES

NO

If so, when?

N/A

Have you ever been convicted of a felony?

YES

NO

If yes, explain

N/A

Address

One Eagle Way

YES

NO

Address

N/A

YES

NO

Address

N/A

YES

NO

EDUCATION
Robert C Byrd High School

From

2013

College

N/A

From

N/A

Other

N/A

From

N/A

N/A

26301

Are you a citizen of the United States?

High School

12/18/15

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

Dr. Geraldine Beckett

Relationship

Company

Harrison County Schools

Phone

Address

234 Crummit Lane

Full Name

Dr. Petrice Duncan

Relationship

Company

Medicare

Phone

Address

345 Something Street

Full Name

Mrs. Nancy Gertrude

Relationship

Company

N/A

Phone

Address

211 Gertrude Lane

Teacher

304-334-2231

Family Friend

304-556-7789

Family Friend

234-334-2234

YES

NO

PREVIOUS EMPLOYMENT
Company

N/A

Phone

Address

N/A

Supervisor

Job Title

N/A

Starting Salary

Responsibilities

N/A

From

To

N/A

N/A

Reason for Leaving

N/A

May we contact your previous supervisor for a reference?

YES

NO

N/A
N/A

N/A

Phone

Address

N/A

Supervisor

Job Title

N/A

Responsibilities

N/A

From

To

N/A

N/A

Reason for Leaving

N/A

May we contact your previous supervisor for a reference?

YES

NO

N/A
N/A

N/A

Phone

Address

N/A

Supervisor

Job Title

N/A

Responsibilities

N/A

From

To

N/A

N/A

Reason for Leaving

N/A

May we contact your previous supervisor for a reference?

YES

$ N/A

Ending Salary

$ N/A

Ending Salary

$ N/A

N/A

$ N/A

NO

Ending Salary

N/A

$ N/A

Company

Starting Salary

N/A

$ N/A

Company

Starting Salary

N/A

N/A

MILITARY SERVICE
Branch

N/A

Rank at Discharge

From
N/A

If other than honorable, explain

N/A

To

Type of Discharge

N/A
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

12-18-15