Information

Full Name: McKeown Jenna G Date: 10/10/17

Last First M.I.
Address: 2931 Waxwing Circle
Street Address Apartment/Unit #
Roanoke Virginia 24018
City State ZIP Code
Phone: (540) 588-0703 E-mail Address: Jennamckeown14@gmail.com

Date Available: 10/20 Social Security No.: 123-45-6789 Desired Salary: $n/a

Position Applied for: Social worker- foster care systems

YES NO YES NO
Are you a citizen of the United States? x If no, are you authorized to work in the U.S.?
YES NO
Have you ever worked for this company? x If yes, when?
YES NO
Have you ever been convicted of a felony? x

If yes, explain:

Education
High School: Cave Spring High School Address:
YES NO
From: 2015 To: 2019 Did you graduate? x Degree:

College: Virginia Tech Address:

YES NO
From: 2019 To: 2023 Did you graduate? x Degree: Bachelors in sociology

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

References
Please list three professional references.

Full Name: Shelly Whitaker Relationship: boss

Company: Bricks 4 Kidz Phone: (123) 456789

Address:

Full Name: Meredith Shuman Relationship: Teacher

Company: Cave Spring High School Phone: (123) 7658378

Address:

Full Name: Amy Smith Relationship: Boss

Company: Bricks 4 Kidz Phone: (764)76383987

Address:
Previous Employment
Company: Bricks 4 Kidz Phone: (123) 445678

Address: Supervisor: Shelly Whitaker

Teacher/host for
Job Title: parties/camps Starting Salary: $8.50 Ending Salary: $8.50

Responsibilities: Teach kids, help them, clean

From: 6/2016 To: now Reason for Leaving: Not enough hours
YES NO
May we contact your previous supervisor for a reference? x

Company: Starbucks Phone: ()

Address: Supervisor:

Job Title: Barista Starting Salary: $8.50 Ending Salary: $8.50

Responsibilities: Making coffee

From: 2/16 To: 8/16 Reason for Leaving: moved

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

Company: Target Phone: (758) 3378938

Address: Supervisor:

Job Title: Cashier Starting Salary: $9 Ending Salary: $9

Responsibilities: Sales associate, checking people out

From: 9/16 To: 12/16 Reason for Leaving: moved

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

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.