Kurtz’s Beach Employment

Personal Information

Full Name:

Email:

Phone:

Home address:

Are you entitled to work in the United States?
YesNo

Are you 18 or older?
YesNo
If yes, Date of Birth

Have you been convicted of a felony or been incarcerated in connection with a felony in the past seven years?
YesNo
If yes, please explain:

Military Service?
YesNo
Branch

What position(s) are you applying for?

Expected hourly rate:

Expected weekly earnings:

Date available:

Prior Work Experience

Current or Most Recent Employer Name:

Employer Address:

Employer Phone:

Name of supervisor:

Dates of employment:
From To

Position/Job Title:

Pay:

Reason for leaving:

Second Most Recent Employer Name:

Employer Address:

Employer Phone:

Name of supervisor:

Dates of employment:
From To

Position/Job Title:

Pay:

Reason for leaving:

Third Most Recent Employer Name:

Employer Address:

Employer Phone:

Name of supervisor:

Dates of employment:
From To

Position/Job Title:

Pay:

Reason for leaving:

 

Education

High School Name:

Last high school year completed:
9101112

College Name:

Last college year completed:
1234

College Major/Degree:

Trade School Name:

Trade School Major:

 

List any applicable special skills or training:

Personal References

First Reference Name:

First Reference Address:

First Reference Phone:

Second Reference Name:

Second Reference Address:

Second Reference Phone:

Third Reference Name:

Third Reference Address:

Third Reference Phone:

 

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I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired. I also provide consent for former employers to be contacted regarding work records.