SAGE INTERIOR DESIGN

Employment Application

APPLICANT INFORMATION
Last Name

Johnson

Street Address

First

Gary

M.I. A

26 Still Street

Apartment/Unit #

City

Clarksburg

State

Phone

304-669-8884

E-mail Address

Date Available

Presently

Position Applied for

Date

Social Security No.

WV

ZIP
shelbyboy97@ma.rr.com

373-48-2472

Desired Salary

open

Any
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, Clarksburg WV

YES

NO

Address

N/A

YES

NO

Address

N/A

YES

NO

EDUCATION
Robert C. Byrd

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

10-15-2015

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

Mr. Jamie Barnard

Relationship

Company

Mountain Shine

Phone

Address

604 Ohio Avenue Nutter fort, WV 26301

Full Name

DR. Geraldine Beckett

Relationship

Company

Robert C. Byrd High School

Phone

Address

162 Crummitt lane Clarksburg, WV 26301

Full Name

Ms. Corra Whaley

Relationship

Company

Whaleys Distributing

Phone

Address

331 Broadway Avenue Clarksburg, WV 26301

Friend

304-669-3447

Former Teacher

304-326-7200

Friend

304-669-3443

YES

NO

PREVIOUS EMPLOYMENT
Company

Raymonds Restaurant

Phone

Address

336 E Pike St, Clarksburg, WV 26301

Supervisor

Job Title

Bus Boy

Starting Salary

Responsibilities

Clean Up, Seat People, Get Drinks For People, Cater

From

To

2015

N/A

Reason for Leaving

N/A

May we contact your previous supervisor for a reference?

YES

Phone

Address

N/A

Supervisor

Job Title

N/A
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
N/A

Phone

Address

N/A

Supervisor

Job Title

N/A
N/A

From

To

N/A

N/A

Reason for Leaving

N/A

May we contact your previous supervisor for a reference?

YES

Ending Salary

$N/A

Ending Salary

$N/A

N/A

NO

N/A

Responsibilities

$9

N/A

$N/A

Company

Starting Salary

Ending Salary

NO

N/A

Responsibilities

Tony Lehosit

$9

Company

Starting Salary

304-622-9016

N/A

$N/A

NO

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