You are on page 1of 3

Peninsula College

Employment Application | Model


Applicant Information

Full Name: Hart Shauntel P Date: 02/15/2017


Last First M.I.

Address: 12 South Orchard Lane


Street Address Apartment/Unit #

Port Angeles WA 98362


City State ZIP Code

Phone: (253) 441-5557 Email shauntelhart@gmail.com

Date Available: Negotiable Social Security No.: xxx-xxx-xxxx Desired Salary: Negotiable

Position Applied for: Level I Secretary

YES NO YES NO
Are you a citizen of the United States? If no, are you authorized to work in the U.S.?

YES NO
Have you ever worked for this company? If yes, when? 2015

YES NO
Have you ever been convicted of a felony?

If yes, explain:

Education

High School: Auburn High Address: Auburn, WA

YES NO
From: 1996 To:2000 Did you graduate? Diploma: Standard

College: Peninsula College Address: Port Angeles, WA

YES NO
From: 2014 To: Did you graduate? Degree: AAS

Other: n/a Address:

YES NO
From: To: Did you graduate? Degree:

References
Please list three professional references.

Full Name: Sherry B. Sparrowk Relationship: Professor


Company: Peninsula College Phone: (360) 417-6375

1
Address: 1502 East Lauridsen Boulevard, Port Angeles, WA 98362

Full Name: Paul Peterson Relationship: Supervisor


Company: Alliance Management Phone:
Address:

Full Name: Kelly Pearson Relationship: Colleague


Company: Peninsula School District Phone: (425) 344-7020
Address: 381 Bywater Way, Port Ludlow, WA 98365

Previous Employment
Company: Port Angeles School District Phone: (360) 457-8575
Address: 216 East Fourth St., Port Angeles, WA 98362 Supervisor: Tamara Elliott

Job Title: Substitute Starting Salary: $11.50 Ending Salary: $11.50

Responsibilities: Substitute for Paraeducator, Custodian, and Secretary positions.

From: 2015 To: Current Reason for Leaving: Still currently employed

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

Company: Alliance Management, Inc Phone: (206) 903-2485


Address: 1515 NW 52nd St B, Seattle, WA 98107 Supervisor: Paul Peterson

Job Title: Facility Manager Starting Salary: $13.75 Ending Salary: $13.75

Responsibilities: Lived onsite managing apartment complex in Auburn, WA.

Bought a house, moved no


From: 2007 To: 2008 Reason for Leaving: longer eligible to manage

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

Company: All Safe Storage Phone: (801) 798-2045


Address: 2023 N Main St, Spanish Fork, UT 84660 Supervisor: Richard Johnson

Job Title: Facility Manager Starting Salary: n/a Ending Salary: n/a

Responsibilities: Lived onsite managing storage facility worked in exchange for rent and utilities.

From: 2004 To:2007 Reason for Leaving: Moved out of state

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

2
Military Service

Branch: n/a 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: 02/16/2017