ORANGEBURG CALHOUN PREP ACADEMY

Employment Application
APPLICANT INFORMATION
Dat
Last Name First M.I.
e
Street Apartment/Unit
Address #
City State ZIP
E-mail
Phone
Address
Date Social Security Desired
Available No. Salary
Position Applied
for
Are you a citizen of the United If no, are you authorized to work in the
YES NO YES NO
States? U.S.?
Have you ever worked for this
YES NO If so, when?
company?
Have you ever been convicted of a If yes,
YES NO
felony? explain

EDUCATION
High Addres
School s
Did you
From To YES NO Degree
graduate?
Colleg Addres
e s
Did you
From To YES NO Degree
graduate?
Addres
Other
s
Did you
From To YES NO Degree
graduate?

REFERENCES
Please list three professional references.
Relationshi
Full Name
p
Company Phone ( )

Address
Relationshi
Full Name
p
Company Phone ( )

Address
Relationshi
Full Name
p
Company Phone ( )

Address
PREVIOUS EMPLOYMENT
Company Phone ( )
Superviso
Address
r
Starting Ending
Job Title $ $
Salary Salary
Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a
YES NO
reference?
Company Phone ( )
Superviso
Address
r
Starting Ending
Job Title $ $
Salary Salary
Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a
YES NO
reference?
Company Phone ( )
Superviso
Address
r
Starting Ending
Job Title $ $
Salary Salary
Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a
YES NO
reference?

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 Date
Please submit application, cover letter and resume to:

Orangeburg Calhoun Prep Academy

c/o OC- Tech
3250 St. Matthew Rd.
Orangeburg, SC 29118
Email: info@orangeburgcalhounprepacademy.com