Publix

Employment Application
Applicant Information
Full Name:

King
Last

Address:

Felisha

First

M.I.

Date:2/23/16

5225 Highland Ave

Street Address

Phone:

Apartment/Unit #

Birmingham

Al

35224

City

State

ZIP Code

2059206151

Date Available:

A.S.A.P

EmailNmking45434543@att.net
Social Security No.:241945338

Desired Salary:Minimum Wage

Position Applied for:

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.?

If yes, when?

If yes, explain:

Education
High School:
From:

2015

Minor High school

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?

References
Please list three professional references.
1

Degree:

YES

NO

Full Name: Mrs. Green

Relationship:Teacher

Company:
Address:
2285 Minor
Pkwy,
Adamsville,
Al 35005

Phone:2053794750

Full Name: Mrs. Cottrell

Relationship:Teacher

Company:
Address:
2285 Minor
Pkwy,
Adamsville,
Al 35005

Phone:2053794750

Full Name: Bridget Evans

Relationship:Sister in law

Company:

Phone:2054345362

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?

Company:

NO

Phone:

Address:

Supervisor:
2

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:

Felisha Nicole King

Date:2/23/16