21THINGS4STUDENTS

Employment Application

APPLICANT INFORMATION
Last Name Verani First Clara M.I. Date

Street Address MacDonald drive Apartment/Unit # 34643

City Sterling Heights State MI ZIP 48310

Phone N/A E-mail Address Kalalastradioto@gmail.com

Date Available Immediately Social Security No. N/A Desired Wage: $8 an hour

Position Applied for Cashier

Are you a citizen of the United States? YES X NO If no, are you authorized to work in the U.S.? YES NO

Have you ever worked for this company? YES NO X If so, when?

Have you ever been convicted of a felony? YES NO X If yes, explain

EDUCATION (PLEASE LIST MOST RECENT FIRST)

School 1 MS2TC Address 27500 Cosgrove Warren, Michigan 48092

From To Did you graduate? YES NO X I am still in the eighth grade

School 2
Grissom Middle Address 35701 Ryan Road Sterling Heights, Michigan 48310

From To Did you graduate? YES NO X I am still in the eighth grade

School 3 Susick Elementary Address 2200 Castleton Dr. Troy, Michigan 48083

From To Did you graduate? YES X NO

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

Full Name Holly Haffner Relationship Teacher

Company Grissom Middle school Phone N/A

Address N/A

Full Name Michelle Kauffold Relationship Private teacher

Company N/A Phone N/A

Address N/A

Full Name Tuyen Duddles Relationship Teacher

Company MS2TC Phone N/A

Address N/A
PREVIOUS EMPLOYMENT

Company Phone

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

MILITARY SERVICE

Branch From To

Rank at Discharge 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