21THINGS4STUDENTS

Employment Application

APPLICANT INFORMATION
Last Name

Abdo

Street
Address

Dat
e
Apartment/Unit
#

First

Sarah

M.I.

State

Michigan

ZIP

33621 Application Dr

City

Sterling Heights

Phone

586-866-2730

Date
2020
Available
Position Applied
Doctor
for
Are you a citizen of the United
States?
Have you ever worked for this
company?
Have you ever been convicted of a
felony?

3-16-16

48310

E-mail
ScuraOtaku@gmail.com
Address
Social Security
Desired
123-45-6789
No.
Wage:

YES

NO

If no, are you authorized to work in the

U.S.?

YES

NO

If so, when?

YES

NO

If yes,
explain

Negotiable

YES

EDUCATION (PLEASE LIST MOST RECENT FIRST)

School 1

Jefferson Elementary

From

School 2

To

Did you
graduate?

Did you
graduate?

From

School 3

Sterling Heights High

From

To

12

YES

NO

Addres
s

Grissom Middle
To

Addres
s

Did you
graduate?

YES

NO

Addres
s
YES

NO

REFERENCES
Please list three professional references you have known at least 3 years and are not friends or relatives.
Full Name

Riley Raegan

Relationshi
p

Company

Sterling Heights High School

Phone

Full Name

Amy Rovner

Relationshi
p

Company

Grissom Middle School

Phone

Full Name

John Piccalo

Relationshi
p

Company

Grissom Middle School

Phone

Teacher

Address
Teacher

Address

Address

Teacher

NO

PREVIOUS EMPLOYMENT
Company

N/A

Phone
Superviso
r

Address
Starting
Salary

Job Title

Ending
Salary

Ending
Salary

Ending
Salary

Responsibilities
From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

NO

Company

Phone

Address

Superviso
r
Starting
Salary

Job Title

Responsibilities
From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

NO

Company

Phone

Address

Superviso
r
Starting
Salary

Job Title

Responsibilities
From

To

Reason for Leaving

May we contact your previous supervisor for a

reference?

YES

NO

MILITARY SERVICE
Branch

N/A

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

Sarah Abdo

Date

Technical Education Centers/Program

3-16-16