THE DEMOCRATIC VOTE

Employment Application fax: 1-877-449-3902

The Democratic Vote

APPLICANT INFORMATION
Last Name Street Address City Phone Birth Date 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 YES YES NO NO NO If no, are you authorized to work in the U.S.? If so, when? If yes, explain YES NO State E-mail Address Social Security No. Desired Salary $15.00 First M.I. Date

Apartment/Unit # ZIP

EDUCATION
High School From College From Other From To Did you graduate? To Did you graduate? To Did you graduate? Address YES Address YES Address YES NO Degree NO Degree NO Degree

REFERENCES
Please list three professional references. Full Name Company Address Full Name Company Address Full Name Company Address Relationship Phone ( ) Relationship Phone ( ) Relationship Phone ( )

PREVIOUS EMPLOYMENT
Company Address Job Title Responsibilities From To Reason for Leaving YES NO Phone Supervisor Starting Salary $ Ending Salary $ ( ) Starting Salary Phone Supervisor $ Ending Salary $ ( )

May we contact your previous supervisor for a reference? Company Address Job Title Responsibilities From To Reason for Leaving

May we contact your previous supervisor for a reference? Company Address Job Title Responsibilities From To Reason for Leaving

YES

NO Phone Supervisor ( )

Starting Salary

Ending Salary

May we contact your previous supervisor for a reference?

YES

NO

MILITARY SERVICE
Branch Rank at Discharge If other than honorable, explain From To

Type of Discharge

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