Mock Job Application

[Fake Company / Awesome Logo]

454 Random Street
Stroudsburg, PA 18360

Phone: [000-000-0000]
Fax: [000-000-0000]

Personal Information
Last

First

MI

SSN#

thomas anassa l
Street Address

City

ST

Email

123456789

anassatomas1030@gmail.com

Zip

Home Phone

Mobile Phone

3345176264

n/a

445 deatsville hwy apt 905 Elmore AL 36054

Are you entitled to work in the United States?

Yes

Are you 18 or older?

No

Have you been conviced of a felony or been incarcerated in connection with a

Yes
No
felony in the past seven years?
Military Service?

Yes

No

Branch

Yes

No

Yes

No

If yes, Date of Birth

If yes, please explain:

Are you a veteran?

What position are you applying for?

How did you hear about this position?

babysitter

online

War

Expected Hourly Rate

Expected Weekly Earnings

Date Available

$10.00

$290.00

any

Current or Most Recent

Prior

Prior

Employer

betty thomas

betty thomas

betty thomas

Address

445 deatsville hwy apt 905

461 lasning street

369 brownstone loop

City, ST, ZIP

elmore al 36054

aurora co 80010

elmore al 36025

Telephone

3345176264

n/a

3345176084

Prior Work Experience

Name of Immediate Supervisor

Dates of Employment

betty thomas

betty thomas
From

To

1/3/16

Position/Job Title

3/16/16

From

betty thomas

4/23/10

To

9/30/10

From

6/27/09

To

10/30/09

babysitter

assistant daycare provider

babysitter

Pay

$25.00

$10.00

$15.00

Reason for Leaving

current

flood

moved

May We Contact

Yes

No

Yes

No

Yes

No

Education
Name/Location

Last Year Complete

09

High School

College/University
Trade School

Degree

10

11

12

Other
List any applicable special skills,
training or proficiencies.

Major or Emphasis

1/3/16

3/16/16

Disclaimer - By signing, I hereby certify that the above information, to the best of my knowledge,
is correct. I understand that falsification of this information may prevent me from being hired or
lead to my dismissal if hired. I also provide consent for former employers to be contacted
regarding work records.

Signature

Date

Anassa Thomas

3/17/16