Name Address City State Zip Phone Email Date of Birth Position Desired Manager Employee Normal Person Number of work hours per week desired 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Days of the week available for work Monday Tuesday Wednesday Thursday Friday Saturday Sunday Hours of the day available for work Hourly wage desired Date available to begin work Can you provide proof of eligibility to work in the United States? Yes No Have you ever been convicted of a felony crime? (*A “yes” does not necessarily disqualify you from employment) Yes No If “Yes,” please list all convictions, dates and states in which the conviction(s) occurred. If you are under 18 years of age, do you have a Wisconsin work permit? Yes No If “No,” when will you obtain your work permit? If you are under 16 years of age, are you aware of the legal limitations on the amount of time you are permitted to work weekly, and during the school year? Yes No List your previous employers, starting with the most recent: 1. Employer Position Reason for Leaving Dates (From - To) Describe your work tasks and responsibilities, and any other information that you consider pertinent to your application. 2. Employer Position Reason for Leaving Dates (From - To) Describe your work tasks and responsibilities, and any other information that you consider pertinent to your application. 3. Employer Position Reason for Leaving Dates (From - To) Describe your work tasks and responsibilities, and any other information that you consider pertinent to your application. 4. Employer Position Reason for Leaving Dates (From - To) Describe your work tasks and responsibilities, and any other information that you consider pertinent to your application. 5. Employer Position Reason for Leaving Dates (From - To) Describe your work tasks and responsibilities, and any other information that you consider pertinent to your application. List any other work or other experiences you think will be useful to us in considering your application. What is the highest level of education you have completed? Grade School High School Technical School 4-Year College/University Post-Secondary/Graduate Degree Other Certification List technical, secondary and post-secondary schools, and other certifications below: 1. Name Years Completed Degree/Area(s) of Study Did you graduate? 2. Name Years Completed Degree/Area(s) of Study Did you graduate? 3. Name Years Completed Degree/Area(s) of Study Did you graduate? 4. Name Years Completed Degree/Area(s) of Study Did you graduate? Are you a veteran of the United States military? Yes No If “Yes,” which branch? Service dates Are you a member of the National Guard? Yes No Please list at least three professional references. If you lack professional references, please list someone who can attest to your character, and ability to take responsibility. 1. Name Relationship to You Years Known Telephone # 2. Name Relationship to You Years Known Telephone # 3. Name Relationship to You Years Known Telephone # 4. Name Relationship to You Years Known Telephone # Thank you for your application. Send
