APPLICATION FOR EMPLOYMENT
Chronic Solutions
212 West Winesap Road #101
Bothell, WA 98012
Today's Date
*
DD
MM
YYYY
Name
*
First
Last
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Home
*
Cell
*
Email
*
Are you legally entitled to work in the United States?
*
Yes
No
Are you 21 years of age or older?
*
Yes
No
Have you ever been discharged from a previous employer?
*
Yes
No
If yes, please explain
*
Position you are applying for?
*
Are you looking for full-time or part-time work?
*
Date available to begin work?
*
Desired Salary?
*
Are you available to work days?
*
Yes
No
Are you available to work evenings?
*
Yes
No
Are you available to work weekends?
*
Yes
No
Are you available to work overtime, if needed?
*
Yes
No
Are there any dates or times where you are not able to work?
*
Mon.
Tue.
Wed.
Thur.
Fri.
Sat.
Sun.
Skills: (please list all pertinent skills related to the position you are applying for)
*
Did you graduate High School or obtain a GED?
*
Yes
No
If no, what is the highest grade level completed?
*
Did you attend College, Trade School, Etc.?
*
Yes
No
If yes, please provide the following:
Name
*
Address
*
City
State / Province / Region
Dates Attended From
*
Date Format: DD slash MM slash YYYY
Dates Attended To
*
Date Format: DD slash MM slash YYYY
Major
*
Did you Graduate?
*
Yes
No
Please provide the following information for your last 3 employers: (Chronologically, starting with most recent)
Employer Name
*
First
Last
Employer Address
*
Employer Phone
*
Supervisor's Name:
*
Salary
*
Please enter a number from
00001
to
100000
.
Job Title
*
Job Duties
*
Employment Dates From
*
Date Format: DD slash MM slash YYYY
Employment Dates To
*
Date Format: DD slash MM slash YYYY
Reason For Leaving
*
May we contact this employer for a reference?
*
Yes
No
Employer Name
*
First
Last
Employer Address
*
Employer Phone
*
Supervisor's Name:
*
Salary
*
Please enter a number from
00001
to
100000
.
Job Title
*
Job Duties
*
Employment Dates From
*
Date Format: DD slash MM slash YYYY
Employment Dates To
*
Date Format: DD slash MM slash YYYY
Reason For Leaving
*
May we contact this employer for a reference?
*
Yes
No
Employer Name
*
First
Last
Employer Address
*
Employer Phone
*
Supervisor's Name:
*
Salary
*
Please enter a number from
00001
to
100000
.
Job Title
*
Job Duties
*
Employment Dates From
*
Date Format: DD slash MM slash YYYY
Employment Dates To
*
Date Format: DD slash MM slash YYYY
Reason For Leaving
*
May we contact this employer for a reference?
*
Yes
No
Professional References: (people not related to you)
Name
*
First
Last
Phone
*
Relationship
*
Years Known
*
Name
*
First
Last
Phone
*
Relationship
*
Years Known
*
Signature:
*
Date:
Date Format: MM slash DD slash YYYY
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