Information Employee

Tina Chancellor’s Employment Application

Application Date: 11/28/2020 Job Title: Teller

Job Location: Antlers

Personal Information First Name: Tina

Last Name: Chancellor

Email: ******************@*****.***

Contact Information Mobile: 903-***-****

Country: US

Address: 611 East Trice Street

City: Hugo

State: OK

Zip Code: 74743

General Information

Are you legally authorized to work in the United States? Yes

Desired Compensation: 10.00 hourly

Available Start Date: 12/10/2029

How did you hear about this opportunity? Online

If referred by a current employee, please give employee name. n/a

Employment :

Current or Most Recent Employer

Are you currently employed? Yes

Employer Name: Homestead

City and State: Hugo ok

Title: Cna

From: 03/2020

To: Still employed

Reason for Leaving: Currently Employed

Rate of Pay: n/a

Direct Supervisor: n/a

Company Phone: n/a

Education/Training

What is your highest level of education completed? Some College

Name of institution(s): Colorado technical university

Graduate? No

Major(s): Business

Degree(s) or Certification(s): Still attending

List any professional licenses: n/a

References

Please list three professional references.

Name: James Butler

Phone: 903-***-****

Name: Patty attaway Phone: 580-***-**** Name: Tammy warren Phone: 580-***-****

Applicant's Statement

I certify that my answers to all questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application or during the pre-employment process may be grounds for my immediate termination.

I have read and agree to this disclaimer. Yes

Applicant Signature: Tina L Chancellor

Date: 12/9/2020

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