SAGE INTERIOR DESIGN

Employment Application

APPLICANT INFORMATION
Last Name

Barnard

Street Address

First

Jacob

604 Ohio Avenue

Apartment/Unit #

City

Clarksburg

State

Phone

304-669-4556

E-mail Address

Date Available

Presently

Position Applied for

Date

Social Security No.

WV

ZIP

Jacob_barnard@outlook.com

367-89-6132

Desired Salary

Open

Salesman
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?

Have you ever been convicted of a felony?

YES

NO

If yes, explain

Address

One Eagle Way, Clarksburg, WV 26301

YES

NO

Address

N/A

YES

NO

Address

N/A

YES

NO

EDUCATION
Robert C. Byrd High School

From

2012

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

12-16-15

To

To

To

2017

N/A

M/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

Mr. Gary Johnson

Relationship

Company

UHC Hospital

Phone

Address

26 Still Street, Clarksburg, WV 26301

Full Name

Dr. Geraldine Beckett

Relationship

Company

Robert C. Byrd High school

Phone

Address

One Eagle Way, Clarksburg, WV 26301

Full Name

Ms. Cora Whaley

Relationship

Company

Whaley Distributing

Phone

Address

331 Broadway Ave., Clarksburg, WV 26301

Family Friend

304-669-1120

Teacher

304-326-7200

Grandmother

304-662-1075

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

12-16-2015