Information

Full Name: Taylor Austin Z Date: 10/13/2017

Last First M.I.
Address: 9534 orchard Drive
Street Address Apartment/Unit #
Bent Mountain VA 24059
City State ZIP Code
Phone: (5402069931) E-mail Address: Jayndayz1@gmail.com

Date Available: 10/16 Social Security No.: 123-45-6789 Desired Salary: $8.00 per hour

Position Applied for: cashier

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

If yes, explain:

Education
High School: Cave spring high Address: 3712 Chaparral Dr
YES NO
From: 2014 To: 2018 Did you graduate? N Degree:

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

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

References
Please list three professional references.

Full Name: Relationship: work

Company: Kmart store shut down Phone: (540) 9820995

Address: 3533 franklin road

Full Name: Relationship: work

Company: Walmart Phone: (540) 7723892

Address: 5350 clearbrook village Ln

Full Name: Relationship: work

Company: walgreens Phone: (540) 725 1546

Address: 4049 brambleton Ae

Previous Employment
Company: Kmart Phone: (540) 9820995

Address: 3533 franklin road Supervisor:

Job Title: cashier Starting Salary: $7.25 Ending Salary: $7.25

Responsibilities: Cashier

From: 4/3/2016 To: 8/4/2016 Reason for Leaving: Work conditions

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

Company: walmart Phone: (540) 7723892

Address: 5350 clearbrook village Supervisor:

Job Title: cashier Starting Salary: $9.00 Ending Salary: $10.00

Responsibilities: cashier

From: 12/3/16 To: 7/25/17 Reason for Leaving: Work conditions

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

Company: walgreens Phone: (540) 725 1546

Address: 4049 brambleton Ave Supervisor:

Job Title: cashier Starting Salary: $9.00 Ending Salary: 9.00

Responsibilities: cashier

From: 9/12/17 To: unknown Reason for Leaving: Unkown

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

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.