SAGE INTERIOR DESIGN

Employment Application

APPLICANT INFORMATION
Last Name

Petrice

Street Address

First

Seth

M.I. T

217 Vermont Avenue

Apartment/Unit #

City

Clarksburg

State

Phone

304-641-9737

E-mail Address

Date Available

Presently

Position Applied for

Date

Social Security No.

West Virginia

ZIP

sethpetrice@gmail.com

344-655-6790

Desired Salary

Open

Computer Software Engineer

YES

NO

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

Have you ever worked for this company?

YES

NO

If so, when?

N/A

Have you ever been convicted of a felony?

YES

NO

If yes, explain

N/A

Address

One Eagle Way

YES

NO

Address

N/A

YES

NO

Address

N/A

YES

NO

EDUCATION
Robert C. Byrd

From

2012

College

N/A

From

N/A

Other

N/A

From

N/A

N/A

2630

Are you a citizen of the United States?

High School

12/15/15

To

To

To

2016

N/A

N/A

Did you graduate?

Did you graduate?

Did you graduate?

Degree

General Diploma

Degree

N/A

Degree

N/A

REFERENCES
Please list three professional references.
Full Name

Dr. Geraldine Beckett

Relationship

Company

Robert C. Byrd High School

Phone

Address

162 Crummitt Lane

Full Name

Mrs. Lin Menendez

Relationship

Company

YMCA

Phone

Address

205 Blain Avenue

Full Name

Mr. Dave Keith Grubb

Relationship

Company

Robert C. Byrd High School

Phone

Address

155 Eagle Street

Teacher

304-326-7200

YMCA Summer Director

304-623-3304

Band Director

304-655-8079

YES

NO

PREVIOUS EMPLOYMENT
Company

YMCA

Phone

Address

245 Baker Street

Supervisor

Job Title

Volunteer Crew Member

Starting Salary

Responsibilities

Supervised children and ensured their safety

From

To

06/15

08/15

Reason for Leaving

$ N/A

YES

Ross Family

Phone

Address

790 Vermont Street

Supervisor

Job Title

Volunteer Crew Member

06/11/
15

Starting Salary

$ N/A

304-312-9000
Ms. Lin Menendez

$ N/A

Ending Salary

$ N/A

Ending Salary

$ N/A

Serving and preparing food for costumers

06/11
/15

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Event ended
YES

NO

Company

N/A

Phone

Address

N/A

Supervisor

Job Title

N/A

Starting Salary

Responsibilities

N/A

From

To

N/A

Ending Salary

NO

Company

From

Ms. Lin Menendez

Summer Break ended

May we contact your previous supervisor for a reference?

Responsibilities

304-678-2156

N/A

Reason for Leaving

N/A

May we contact your previous supervisor for a reference?

YES

N/A
N/A

$ N/A

NO

N/A

MILITARY SERVICE
Branch

N/A

Rank at Discharge

From
N/A

If other than honorable, explain

N/A

To

Type of Discharge

N/A
N/A

N/A

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

12/17/15