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Wayne Opportunity Center, Inc.
EMPLOYMENT APPLICATION
Please complete the following and submit the
application.
First Name:
M.I.:
Last Name:
Address:
Social Security No.:
Email:
Phone:
Cell:
Date Availabe:
Position Applied for:
Desired Salary: $
Are you a citizen of the United States?
Yes
No
If no, are you authorized to work in the US?
Yes
No
Have you ever worked for this company?
Yes
No
If so, when?:
High School:
From: _________ To: ___________
Address:
Did you graduate?:
Yes
No
Degree:
College 1:
From: _________ To: ___________
Address:
Did you graduate?:
Yes
No
Degree:
College 2:
From: _________ To: ___________
Address:
Did you graduate?:
Yes
No
Degree:
Professional Reference 1:
Professional Reference 2:
Professional Reference 3:
Profession:
Profession:
Profession:
Contact No.:
Contact No.:
Contact No.:
Employment 1:
From: _________ To: ___________
Address:
Supervisor Name:
Phone
Job Title:
Responsibilities:
Starting Salary:
Reason for Leaving:
Ending Salary:
May we contact your previous supervisor for a reference?
Yes
No
Employment 2:
From: _________ To: ___________
Address:
Supervisor Name:
Phone
Job Title:
Responsibilities:
Starting Salary:
Reason for Leaving:
Ending Salary:
May we contact your previous supervisor for a reference?
Yes
No
Employment 3:
From: _________ To: ___________
Address:
Supervisor Name:
Phone
Job Title:
Responsibilities:
Starting Salary:
Reason for Leaving:
Ending Salary:
May we contact your previous supervisor for a reference?
Yes
No
Have you ever served in the United States Military?
Yes
No
Branch of Service
From: _____ To: _____
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
I certify that my answers are true and complete to the best of my knowlege. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Your Signature
Clear
Submit
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