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This generic application is provided by WorkSource Washington. This form complies with federal and state laws against discrimination;
however, employers using this form should check local ordinances. WorkSource Washington and Washington State Employment Security
are not responsible for the misuse of information provided on this form. Provide all information requested by printing in ink or typing. Use
the 'TAB' key to move through the document.
GENERAL INFORMATION
Name (Last)
(First)
Gill
Nyssa
(City)
Sanger
E-Mail Address
(State)
CA
(Middle Initial)
Home Telephone
() -
(Zip)
Other Telephone
93657
shebadango1@aol.com
Yes
No
POSITION
Position Or Type Of Employment Desired
Are you able to perform the essential functions of the job you are applying for, with or
without reasonable accommodation?
Yes
No
Will Accept:
Part-Time
Full-Time
Temporary
Salary Desired
Date Available
immediately
Shift:
Day
Swing
Graveyard
Rotating
Yes
No
Dates
Attended
Month/Year
From
To
From
To
From
To
From
To
Credits Earned
Quarterly or
Other
Semester
(Specify)
Hours
Graduate
Yes
No
Yes
No
Yes
No
Yes
No
Degree
& Year
Major
or Subject
Number
Where Issued
Expiration Date
Number
Where Issued
Expiration Date
Number
Where Issued
Expiration Date
Date of Entry
Date of Discharge
SPECIAL SKILLS (List all pertinent skills and equipment that you can operate)
(Maximum 1000 characters)
-Organization
() -
Telephone Number
20+
From (Month/Year)
Aug 2014
To (Month/Year)
present
Hours Per Week
withVary
Last Salary
-Supervisor
Monica Pruneda
Still working
Employer Sara Smith
Address
Job Title Assistant (volunteer)
Telephone Number
() -
Yes
No
From (Month/Year)
Sep 2013
To (Month/Year)
present
-Book Processing
-Book Organization and management
vary
Last Salary
-Supervisor
Sara Smith
Reason For Leaving
still working
Employer
Address
Job Title
Specific Duties (Maximum 1000 characters)
() -
Yes
No
From (Month/Year)
To (Month/Year)
Last Salary
Supervisor
Employer
Address
Telephone Number
Job Title
Specific Duties (Maximum 1000 characters)
() -
Yes
No
From (Month/Year)
To (Month/Year)
Last Salary
Supervisor
Yes
No
I certify the information contained in this application is true, correct, and complete. I understand that, if employed, false
statements reported on this application may be considered sufficient cause for dismissal.
WorkSource Washington and Washington State Employment Security are equal opportunity employers and providers of employment and training services.
Auxiliary aids and services are available to persons with disabilities upon request.