CAREER EXPLORATIONS

Employment Application

APPLICANT INFORMATION
Last Name
Street
Address

Harriman

Dat
e
Apartment/Unit
#

First

Larry

M.I.

State

MI

ZIP

26650 Normandy St.

City

Roseville

Phone

(586) 864-0435

Date
5/27/16
Available
Position Applied
Cashier
for
Are you a citizen of the United
States?
Have you ever worked for this
company?
Have you ever been convicted of a
felony?

5/21/16

48066

E-mail
larryharriman@outlook.com
Address
Social Security
Desired
xxx-xx-xxxx
No.
Wage:

YES

NO

If no, are you authorized to work in the

U.S.?

YES

NO

If so, when?

YES

NO

If yes,
explain

$8.50/hr

YES

EDUCATION (PLEASE LIST MOST RECENT FIRST)

School 1

Fraser High School

From

2013

To

201
6

Did you
graduate?

School 2
From

34270 Garfield Rd, Fraser, MI 48026

YES

NO

Addres
s
To

Did you
graduate?

YES

NO

Addres
s

School 3
From

Addres
s

To

Did you
graduate?

YES

NO

REFERENCES
Please list three professional references you have known at least 3 years and are not friends or relatives.
Full Name

Relationshi
p

Company

Phone

Address
Full Name

Relationshi
p

Company

Phone

Address
Full Name

Relationshi
p

Company

Phone

Address

NO

PREVIOUS EMPLOYMENT
Company

Jimmy Johns

Phone

Address

31205 Utica Rd, Fraser Mi

Superviso
r

Job Title

In-Shop

Responsibilities

Starting
Salary

(586) 296-7777
Natalie

$8.15/hr

Ending
Salary

$8.15/hr

Ending
Salary

Ending
Salary

Take orders, prepare food, answer phone calls, operate cash register

June
Novemb
From
To
Reason for Leaving
2015
er 2016
May we contact your previous supervisor for a
reference?

To focus on school
YES

NO

Company

Phone

Address

Superviso
r
Starting
Salary

Job Title

Responsibilities
From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

NO

Company

Phone

Address

Superviso
r
Starting
Salary

Job Title

Responsibilities
From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

NO

MILITARY SERVICE
Branch

From

To

Rank at Discharge

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

Larry Harriman III

Date

05/21/16