Employment Information Description of Duties Employer/Kind of Business Position Title Street Address Specific Duties Immediate Supervisor/Title Telephone Number Dates of Employment (Month/Year) Hourly Rate/Salary From: To: Starting: Final: Part-Time Full-Time Reason for Leaving EDUCATION/SKILLS RECORD Please list education or specialized experience that relates to the position(s) for which you are applying. Exclude names or terms that indicate, for example, race, color, religion, sex, disability, or national origin. Circle Highest Grade Completed: 6 7 8 9 10 11 12 College: 1 2 3 4 5 ___ Did You Graduate? ___Yes ____No Post- High School Name of School From To Major Degree Type College/University Graduate School If required by the job you have applied for, have you had training/course work or experience in (please check those that apply): Typing Word Processing Data Entry PC/Computer Terminal Calculator/Adding Machine Dictation Equipment Shorthand/Speedwriting Please list any other types of equipment you can operate or skills you possess, which you feel would be an asset in the position for which you are applying: LICENSES AND CERTIFICATES If a license, certificate, or other authorization to practice a trade or profession is required for the position for which you are applying, complete the following questions: Name of Trade or Profession License Number Granted by City and/or State Specialty Licensed From: To: APPLICANT'S STATEMENT
Employment Information Description of Duties Employer/Kind of Business Position Title Street Address Specific Duties Immediate Supervisor/Title Telephone Number Dates of Employment (Month/Year) From: To: Hourly Rate/Salary Starting: Final: Part-Time Full-Time Reason for Leaving EDUCATION/SKILLS RECORD Please list education or specialized experience that relates to the position(s) for which you are applying. Exclude names or terms that indicate, for example, race, color, religion, sex, disability, or national origin. Circle Highest Grade Completed: 6 7 8 9 10 11 12 College: 1 2 3 4 5 ___ Did You Graduate? ___Yes ____No Post- High School Name of School From To Major Degree Type College/University Graduate School If required by the job you have applied for, have you had training/course work or experience in (please check those that apply): Typing Word Processing Data Entry PC/Computer Terminal Calculator/Adding Machine Dictation Equipment Shorthand/Speedwriting Please list any other types of equipment you can operate or skills you possess, which you feel would be an asset in the position for which you are applying: LICENSES AND CERTIFICATES If a license, certificate, or other authorization to practice a trade or profession is required for the position for which you are applying, complete the following questions: Name of Trade or Profession License Number Granted by City and/or State Specialty Licensed From: To: APPLICANT'S STATEMENT