MAUI TAN-Application for Employment
PERSONAL INFORMATION
Date:
_____________________
Full Name ____________________________________________________
Social Security No: ____________________________
Home Address (City, state, zip):
_________________________________________________________________________________
Home Phone___________________________ Business Phone: _________________________
May we contact you at work? Y N
Position Applying for _________________________________Pay rate desired__________
Date Available ____________________
Circle last year of school attended: 10 11 12 College: 1 2 3 4
Are you interested in (check all that apply)
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Full-time
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Part-time
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Temporary
□
Summer
Days and hours available:
Date Mon Tues Wed Thurs Fri Sat Sun
From:
To:
EMPLOYMENT HISTORY
List your last two employers starting with your most recent position.
May we contact your present employer?
□
□
□
Yes
□
No
Past employer?
Yes
No.
Please indicate if you were employed under a different name:
Name & Address of Employer
__________________________________________________________________________________
__________________________________________________________
Phone ______________________ Dates: From ___________ to _________
Position or Title _______________________ Salary or Wages ____________________
List Major Duties:
______________________________________________________________________________________
Reason for
leaving:______________________________________________________________________________
Name & Address of Employer
__________________________________________________________________________________
__________________________________________________________
Phone ______________________ Dates: From ___________ to _________
Position or Title _______________________ Salary or Wages ____________________
List Major Duties:
______________________________________________________________________________________
Reason for
leaving:______________________________________________________________________________