Zaxbys

Employment Application
Applicant Information
Full Name:

Bascomb
Last

Address:

Chasity

Amya

First

M.I.

Date:February 22,2016

2421 crossbow drive

Street Address

Phone:

Apartment/Unit #

birmingham

AL

35214

City

State

ZIP Code

205-821-9803

Date Available:

ANY

Email CBASCOMB11@GMAIL.COM
Social Security No.:420-2565-45

Desired Salary:$200-$400

Position Applied for: Cook , Overtime

Are you a citizen of the United States?
Have you ever worked for this company?
Have you ever been convicted of a felony?

YES

NO

YES

NO

YES

NO

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

YES

If yes, when?

If yes, explain:

Education
High School:

Minor high school

From:

To:

Address:2285 Minor Pkwy, Adamsville, AL 35005

Did you graduate?

College:
From:

NO

YES

NO

YES

NO

Diploma::

Address:
To:

Did you graduate?

Other:
From:

YES

Degree:

Address:
To:

Did you graduate?

Degree:

References
Please list three professional references.
Full Name: Jacolbi b.

Relationship:Friend

Company:

Phone:205-276-3346
1

NO

Address:
Full Name: Juwan W.

Relationship: Neighbors

Company:

Phone:205-903-8011

Address:
Full Name: Mrs.knight

Relationship: Friend

Company:

Phone:205-207-6173

Address:

Previous Employment
Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:$

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:

YES

May we contact your previous supervisor for a reference?

NO

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:$

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:

YES

May we contact your previous supervisor for a reference?

NO

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:$

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:

YES

May we contact your previous supervisor for a reference?

NO

Military Service
Branch:

From:

Rank at Discharge:

To:

Type of Discharge:

If other than honorable, explain:

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:

Chasity A. Bascomb

Date: February 22, 2016