21THINGS4STUDENTS

Employment Application

APPLICANT INFORMATION
Dat
Last Name Tolbert First Kellie M.I. May 18 2017
e
Street Apartment/Unit
700th st
Address #
City Sparks State NV ZIP 89431
E-mail
Phone (775) 357 -2629 2151566kat@gmail.com
Address
Date Social Security Desired
July 27 123-45-6789 negotiable
Available No. Wage:
Position Applied
Position.
for
Are you a citizen of the United If no, are you authorized to work in the
YES x NO YES x NO
States? U.S.?
Have you ever worked for this
YES NOx If so, when?
company?
Have you ever been convicted of a If yes,
YES NOx
felony? explain

EDUCATION (PLEASE LIST MOST RECENT FIRST)

Addres
School 1 Sparks high school
s
820 15th St, Sparks, NV 89431
2 Did you
From To 2020 YES x NO
0 graduate?
School 2 Addres
Dilworth middle school
s
255 Prater Way, Sparks, NV 89431
2 Did you
From To 2016 YES x NO
0 graduate?
Addres
School 3 Libby c booth elementary
s
1450 Stewart St, Reno, NV 89502
2 Did you
From To 2014 YES x NO
0 graduate?

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

Date
Signature Kellie Tolbert 5/22
/2017