SAGE INTERIOR DESIGN

Employment Application

APPLICANT INFORMATION
Last Name

White

Street
Address

First

Dat
e
Apartment/Unit
#

Brooklyn

M.I. N

6468 Mount Clare

City

Mount Clare

State

Phone

304-669-3685

Date
12-15-15
Available
Position Applied
Any
for
Are you a citizen of the United
States?
Have you ever worked for this
company?
Have you ever been convicted of a
felony?

WV

ZIP

E-mail
bwhite1017@aol.com
Address
Social Security
Desired
233-56-7887
No.
Salary

YES

NO

If no, are you authorized to work in the

U.S.?

YES

NO

If so, when?

YES

NO

If yes,
explain

Addres
s

One Eagle Way Clarksbyr, WV 26301

YES

NO

Addres
s

N/A

YES

NO

Addres
s

N/A

YES

NO

Robert C Byrd High School

From

2013

Colleg
e

N/A

From

N/A

Other

N/A

From

N/A

To

To

To

2016

N/A

N/A

N/A

26408

EDUCATION
High
School

12-15-15

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

Nicole Heineman

Relationshi
p

Company

Journeys

Phone

Address

125 Ken Road Fairmont, WV 26554

Full Name

John Cooper

Relationshi
p

Company

Splash Zone

Phone

Address

305 Hickman Street Clarksburg, WV 26301

Full Name

Geraldine Beckett

Relationshi
p

Company

Harrison County Board of Education

Phone

Address

162 Crummitt Lane Clarksburg, WV 26301

Manager

412-0770-8460

Boss

304-641-1685

Teacher

304-326-7200

YES

NO

PREVIOUS EMPLOYMENT
Company

Journeys

Phone

Address

1221 Meadowbrook Mall Bridgeport, WV 26308

Superviso
r

Job Title

Manager

Starting
Salary

Responsibilities

Sales Associate

From

To

2014

2016

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

Address

1236 Medow Lane Clarksburg, WV 26301

Superviso
r

Job Title

Lifeguard

Starting
Salary

To

2013

2017

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

Address

N/A

Superviso
r

Job Title

N/A

Starting
Salary

To

N/A

N/A

Reason for Leaving

May we contact your previous supervisor for a

reference?

Ending
Salary

$9.00

Ending
Salary

$ N/A

NO
Phone

From

John Cooper

Im leaving for college.

N/A

N/A

304-659-8585

$8.25

Company

Responsibilities

$8.75

NO
Phone

From

Ending
Salary

N/A

Splash Zone

Guard the Water

John Dept

$8.25

Company

Responsibilities

304-842-2596

N/A
N/A

$ N/A

N/A
YES

NO

MILITARY SERVICE
Branch

N/A

Rank at Discharge

From
N/A

If other than honorable,

explain

N/A

To

N/A

Type of Discharge

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

Brooklyn White

Date

12-15-15