Peninsula College

Employment Application | Model

Applicant Information
Full Name: Wheeler
Last

Address:

Heather

First

M.I.

Date:2/16/15

260 W Division St
Street Address

Phone:

Apartment/Unit #

Forks

WA

98331

City

State

ZIP Code

360-640-5577

Date Available:

Now

Email hwheeler1988@gmail.com
Social Security No.: ***-**-****

Desired Salary: Negotiable

Position Applied for: Administrative Assistant

Are you a citizen of the United States?
Have you ever worked for this company?
Have you ever been convicted of a felony?

YES

NO

YES

NO

YES

NO

If no, are you authorized to work in the U.S.?

YES

NO

If yes, when?

If yes, explain:

Education
High School:
From:

Port Angeles High School

2002

To: 2006

Did you graduate?

College: Peninsula College

From:

2015

To: 2016

YES

NO

Diploma: GED - 2006

Address: 1502 E Lauridsen Blvd, Port Angeles, WA 98362

Did you graduate?

Other:
From:

Address: 304 E Park Ave, Port Angeles, WA 98362

YES

NO

YES

NO

Associate of Science,
Administrative Office Systems,
Degree:Medical Specialization

Address:
To:

Did you graduate?

Degree:

References
Please list three professional references.
Full Name:

Shane Miller

Relationship: Previous Employer

1

Company:

Call Centers 24x7

Address:

228 W 1st St, Ste O, Port Angeles, WA 98362

Full Name:

Joyce Bay

Company:

Crestwood Convalescent Center

Address:

1116 E Lauridsen Blvd, Port Angeles, WA 98362

Full Name:

Dan Miller

Company:

Armory Square Professional Center

Address:

Phone: 360-477-0358

Relationship: Previous Employer

Phone: 360-452-9206

Relationship: Employer
Phone: 360-461-0450

st

228 W 1 St, Port Angeles, WA 98362

Previous Employment
Company:

Call Centers 24x7

Phone: 360-452-4527

Address:

228 W First St, Ste O

Job Title:

Operations Manager

Supervisor: Shane Miller

Starting Salary:$ 9.50/hour

Ending Salary:$ 13/hour

Handled client calls, trained new employees, wrote procedure documentation, supervised
Responsibilities: employees, evaluated work
From:

3/2007

To: 8/2014

Reason for Leaving: Laid off

YES

May we contact your previous supervisor for a reference?

Company:

Crestwood Convalescent Center

Address:

1116 E Lauridsen Blvd

Job Title:

Culinary Aide

NO

Phone: 360-452-9206
Supervisor: Joyce Bay
Starting Salary:$ 8.75/hour

Ending Salary:$ 9.13/hour

Responsibilities: Assisted serving meals, maintained information on state health regulations

From:

8/2007

To: 10/2012

Reason for Leaving: Relocation

YES

May we contact your previous supervisor for a reference?

NO

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:$

Responsibilities:
From:

To:

Reason for Leaving:

Ending Salary:$

YES

May we contact your previous supervisor for a reference?

NO

Military Service
Branch:

From:

Rank at Discharge:

To:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or
interview may result in my release.
Signature:

Date: