EMPLOYMENT / JOB APPLICATION

PERSONAL INFORMATION

FULL NAME: Joshua Matthew Davis DATE: 3/1/21

First Middle Last

ADDRESS: 13 Roundabout Lane

Street Address Apt/Suite

Adairsville Georgia 30103

City State Zip Code

E-MAIL: spyder07413@gmail.com PHONE: (470) 232-4851

SOCIAL SECURITY NUMBER (SSN): XXX-XX-XXXX

DATE AVAILABLE: As soon as possible DESIRED PAY: ______☐ HOUR ☐ SALARY

POSITION APPLIED FOR: anywhere needed

EMPLOYMENT DESIRED: ☐ FULL-TIME ☐ PART-TIME ☐ SEASONAL

EMPLOYMENT ELIGIBILITY

ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO*

HAVE YOU EVER WORKED FOR THIS EMPLOYER? ☐ YES* ☐ NO

*IF YES, WRITE THE START AND END DATES: ____________________________________

HAVE YOU EVER BEEN CONVICTED OF A FELONY? ☐ YES* ☐ NO

*IF YES, PLEASE EXPLAIN: ____________________________________________________

EDUCATION

HIGH SCHOOL: Adairsville CITY / STATE: Adairsville, Ga

FROM: Aug 2017 TO: Current (May 2021)

GRADUATE? ☐ YES ☐ NO DIPLOMA: Still enrolled

COLLEGE: _____________________ CITY / STATE: _____________________

FROM: _____________________ TO: _____________________

GRADUATE? ☐ YES ☐ NO DEGREE: _____________________

OTHER: _____________________ CITY / STATE: _____________________

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FROM: _____________________ TO: _____________________

DEGREE/CERTIFICATION: _____________________

OTHER: _____________________ CITY / STATE: _____________________

FROM: _____________________ TO: _____________________

DEGREE/CERTIFICATION: _____________________

PREVIOUS EMPLOYMENT

EMPLOYER 1: Kohl’s
Company / Individual

E-MAIL: kohlsemailaddress1@gmail.com PHONE: (770) 607-7955

ADDRESS: 600 E Main St

Street Address Apt/Suite

Cartersville Georgia 30103

City State Zip Code

STARTING PAY: $ 9.50 ☐ HOUR ☐ SALARY ENDING PAY: $ 9.50 ☐ HOUR ☐ SALARY

JOB TITLE: Associate RESPONSIBILITIES: POC, greeter, fitting rooms, shoes, WJM,
and men’s

FROM: September 2021 TO: February 2021

REASON FOR LEAVING: Terrible management, Associates treated poorly

EMPLOYER 2: __________________________________________________________
Company / Individual

E-MAIL: __________________________________ PHONE: _____________________

ADDRESS: ____________________________________________________________
Street Address Apt/Suite

____________________________________________________________
City State Zip Code

STARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY

JOB TITLE: ______________ RESPONSIBILITIES: _____________________________

FROM: _____________________ TO: _____________________

REASON FOR LEAVING: _______________________________________________________

EMPLOYER 3: __________________________________________________________

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 Company / Individual

E-MAIL: __________________________________ PHONE: _____________________

ADDRESS: ____________________________________________________________
Street Address Apt/Suite

____________________________________________________________
City State Zip Code

STARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY

JOB TITLE: ______________ RESPONSIBILITIES: _____________________________

FROM: _____________________ TO: _____________________

REASON FOR LEAVING: _______________________________________________________

REFERENCES
(PROFESSIONAL ONLY)

FULL NAME: Kerri Stone RELATIONSHIP: Manager

First Last

COMPANY: Kohls TITLE: ______________

E-MAIL: __________________________________ PHONE: (770) 607-7955

FULL NAME: Chris Davidson RELATIONSHIP: Teacher

First Last

COMPANY: ________________________________ TITLE: ______________

E-MAIL: cdavidson19@gmail.com PHONE: (XXX) XXX-XXXX

FULL NAME: _______________________________ RELATIONSHIP: ______________

First Last

COMPANY: ________________________________ TITLE: ______________

E-MAIL: __________________________________ PHONE: _____________________

MILITARY SERVICE

ARE YOU A VETERAN? ☐ YES ☐ NO

BRANCH: _____________________ RANK AT DISCHARGE: _____________________

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FROM: _____________________ TO: _____________________

TYPE OF DISCHARGE: _____________________

IF NOT HONORABLE, PLEASE EXPLAIN: ______________________________________

BACKGROUND CHECK CONSENT

IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? ☐ YES ☐ NO

DISCLAIMER

Applicant understands that this is an Equal Opportunity Employer and committed to excellence
through diversity. In order to ensure this application is acceptable, please print or type with the
application being fully completed in order for it to be considered.

Please complete each section EVEN IF you decide to attach a resume.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this
application leads to my eventual employment, I understand that any false or misleading
information in my application or interview may result in my employment being terminated.

SIGNATURE Joshua M Davis DATE 3/1/2021

PRINT NAME Joshua M Davis

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