Time Part Temporary

APPLICATION FOR EMPLOYMENT

POSITION(S) APPLIED FOR: DATE: NAME: Last First Middle

ADDRESS: Street City State Zip

TELEPHONE: SOCIAL SECURITY NUMBER: If you are under 18, can you furnish a work permit Yes No Have you ever filed an application here before Yes No Have you ever been employed here before Yes No Are you legally eligible for employment in this country Yes No

(Proof of U.S. citizenship or immigration status will be required upon employment.) Date available for work / / Type of employment desired: Full-Time Part-Time Temporary (Seasonal, Internship, etc.) Driver’s License Number (If required for job) State EMPLOYMENT HISTORY: List your last three (3) employers, assignments or volunteer activities starting with the most recent, include military experience. Dates Employed Employer Telephone #

From: To: Job Title Address

Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving Rate of Pay

Start $ per Final $ per May we contact:

Yes No

Dates Employed Employer Telephone #

From: To: Job Title Address

Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving Rate of Pay

Start $ per Final $ per May we contact:

Yes No

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Dates Employed Employer Telephone #

From: To: Job Title Address

Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving Rate of Pay

Start $ per Final $ per May we contact:

Yes No

SKILLS AND QUALIFICATIONS

Summarize special skills and qualifications acquired from employment or other experiences that may qualify your for work with WESTCO. EDUCATIONAL BACKGROUND

NAME & LOCATION YEARS COMPLETED DID YOU GRADUATE COURSE OF STUDY High School

College Major Degree

Other

REFERENCES

NAME TELEPHONE NUMBER YEARS KNOWN It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representative for seeking such information and all other persons, corporations or organizations for furnishing such information. Signature of Applicant Date / /

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