Name: Lions Club’s free KidSight vision screening at Milberger’s
Start: 2020-06-06T09:00:00+00:00
End: 2020-06-06T14:00:00+00:00
Location: Milberger Nursery

Date*
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Position Applying For*
Personal Information
Name*
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Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Alternative Phone

Have you ever been convicted of, pled guilty to, or received deferred adjudication for, any felony of any kind, or any misdemeanor involving dishonesty or violence?*
- Yes
- no
If yes, state the nature of the crime(s), when and where you were convicted, and the disposition of the case:
(NOTE: [An applicant’s criminal history will not be an absolute bar to employment. Information regarding the applicant’s criminal record will be reviewed in light of all the surrounding circumstances, including age at the time of the offense, seriousness and nature of the offense, rehabilitation, relationship of the offense to employment, and federal and state statutory requirements.)

Educational Background
Degree*
Major
Describe course of study
Describe specialized training, apprenticeship, skills, and extra-curricular activities:
Honors Received:

Employment Experience
Start with your present or last job. Include military service assignments and volunteer activities.
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Supervisor Name
First Last
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Reason for Leaving
Job Title and Nature of Work
Name of Employer
Type of Business
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First Last
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Reason for Leaving
Job Title and Nature of Work
Name of Employer
Type of Business
Address
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Phone
Supervisor Name
First Last
Start Date
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End Date
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Reason for Leaving
Job Title and Nature of Work
Name of Employer
Type of Business
Address
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Supervisor Name
First Last
Start Date
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End Date
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Reason for Leaving
Job Title and Nature of Work
Unemployment
List any gaps in employment of one month or more, other than school and military service.
Special Skills and Qualifications
Summarize any special training, skills, and qualifications acquired from employment or other experience.

Personal References
List three references who are not related to you and are not previous employers
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First Last
Phone
Occupation
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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First Last
Phone
Occupation
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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
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Occupation
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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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