Application for Employment

(an equal opportunity employer)

PERSONAL INFORMATION

Date_April 24th, 2017__________________________________________________

Name Stoney Caylinn M 386230733

Last First Middle Initial Social Security Number

Present Address 3671 Orleans Way Holt MI 48842

Street City State Zip

Permanent Address 3671 Orleans Way Holt MI 48842

Street City State Zip

Phone No. ( 517 ) 243-6176 Height 52 Weight 110 pounds

EMPLOYMENT DESIRED

Position : Nurse Date Available : Immediately Salary Range Desired : Negotiable

O, I am not
N May We Inquire
Are You Employed Now? currently employed Of Your Present Employer? N/A

Have You Ever Applied to this Company Before? NO Where? N/A When? N/A

EDUCATION
Name and Location of School No. of Years Did You Subjects Studied
Attended Graduate?
-geometry -biology
High School On track -algebra -earth science
4 years to graduate - advanced algebra -human genetics
Holt High School this year, -U.S. History -chemistry
June 4th -world history -anatomy
-economics -american
literature
-english -modern american issues
-psychology -gym
-nutrition and wellness

College N/A N/A N/A

N/A

College N/A N/A N/A

N/A

Trade, Business or
Correspondence N/A N/A N/A
School
N/A

Other N/A N/A N/A

N/A
GENERAL

Subjects of Special Study or Research Work: Human Anatomy

Equipment or Instruments You Can Operate Well: I can properly use a stethoscope and use a cuff to take a patient's
blood pressure

What Foreign Languages Do You Speak fluently? None Read? None Write? None

Military Present Membership in

Service N/A Rank N/A National Guard or Reserves? N/A
(CONTINUED ON OTHER SIDE)

FORMER EMPLOYERS List past employers below, starting with the most recent.

Date Name, Address and Phone of Position Salary Why did you leave?
Month and Year Employer
From___________
To
From___________
To
From___________
To
From___________
To
From___________
To

REFERENCES: Give below the names of three persons not related to you, whom you have known at least one year.
Name Address Occupation Years Acquainted
1
Dustin M Boehmer 5794 MacMillan Way Lansing, Mi 48911 Horse Trainer 4 years

2
Chelsea Slaght Edgar Rd, Mason Mi 8 years

3
Anthony Dionise Lansing Mi

PHYSICAL RECORD: Do you have any physical condition which may limit your ability to perform the job applied for?
Explain: This does not apply to me

In Case of
Emergency Notify Danielle Marie Martin-Stoney 3671 Orleans Way ( 517 )927-5294
Name Address Phone No.
I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of
facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and
may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.

Date 5/ 22 /17 Signature: Caylinn Stoney

DO NOT WRITE BELOW THIS LINE

Interviewed By Date

REMARKS:

Neatness Character
Personality Ability
Hired For Dept. Position Will Report Salary

Approved: 1. 2. 3.
Employment Manager Dept Head General Manager

Adapted with permission for student practice from Form M660-26NR Wilson Jones Company