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:

     

    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.