EMPLOYMENT / JOB APPLICATION

PERSONAL INFORMATION

FULL NAME: __Dylan________________Maldonado___ DATE: __3/1/2021________

ADDRESS: ____19 Rocky Ave Nw______________________

____Cartersville________GA_______________30120_________
City State Zip Code

E-MAIL: [email protected]_____ PHONE: __470-338-0243_____

SOCIAL SECURITY NUMBER (SSN): _xxx__-_xx_-_xxxx__

DATE AVAILABLE: ___earliest as possible_ DESIRED PAY: $__15___ X HOUR ☐ SALARY

POSITION APPLIED FOR: ____Front of Store Guest Advocate___________________

EMPLOYMENT DESIRED: ☐ FULL-TIME X PART-TIME ☐ SEASONAL

EMPLOYMENT ELIGIBILITY

ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? X YES ☐ NO*

HAVE YOU EVER WORKED FOR THIS EMPLOYER? ☐ YES* X NO

*IF YES, WRITE THE START AND END DATES: _____________________________

HAVE YOU EVER BEEN CONVICTED OF A FELONY? ☐ YES* X NO

*IF YES, PLEASE EXPLAIN: ____________________________________________________

EDUCATION

HIGH SCHOOL: ____Adairsville High School_______ CITY / STATE: _____GA______

FROM: ____2017______ TO: __________2021__________

GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________

COLLEGE: _____________________ CITY / STATE: _____________________

FROM: _____________________ TO: _____________________

GRADUATE? ☐ YES ☐ NO DEGREE: _____________________

OTHER: _____________________ CITY / STATE: _____________________

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FROM: _____________________ TO: _____________________

DEGREE/CERTIFICATION: _____________________

OTHER: _____________________ CITY / STATE: _____________________

FROM: _____________________ TO: _____________________

DEGREE/CERTIFICATION: _____________________

PREVIOUS EMPLOYMENT

EMPLOYER 1: _______________Ultimate Nails______________________________

E-MAIL: __________________________________ PHONE: _____________________

ADDRESS: _____6100 Joe Frank Harris Pkwy NW______________________

_Adairsville____________GA__________________30103____________
City State Zip Code

STARTING PAY: $___25____ ☐ HOUR X SALARY ENDING PAY: $___35___ ☐ HOUR X SALARY

JOB TITLE: __Nail Tech_______ RESPONSIBILITIES: ______Doing Nails__________

FROM: _______2019 June___________ TO: ______2020 Oct__________

REASON FOR LEAVING: _______________New Job____________________________

EMPLOYER 2: __________________________________________________________
Company / Individual

E-MAIL: __________________________________ PHONE: _____________________

ADDRESS: ____________________________________________________________
Street Address Apt/Suite

____________________________________________________________
City State Zip Code

STARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY

JOB TITLE: ______________ RESPONSIBILITIES: _____________________________

FROM: _____________________ TO: _____________________

REASON FOR LEAVING: _______________________________________________________

EMPLOYER 3: __________________________________________________________
Company / Individual

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E-MAIL: __________________________________ PHONE: _____________________

ADDRESS: ____________________________________________________________
Street Address Apt/Suite

____________________________________________________________
City State Zip Code

STARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY

JOB TITLE: ______________ RESPONSIBILITIES: _____________________________

FROM: _____________________ TO: _____________________

REASON FOR LEAVING: _______________________________________________________

REFERENCES
(PROFESSIONAL ONLY)

FULL NAME: __ _________ ________ RELATIONSHIP: ____ _____

COMPANY: ________________________________ TITLE: ______________

E-MAIL: __________________________________ PHONE: _____________________

FULL NAME: _______________________________ RELATIONSHIP: ______________

COMPANY: ________________________________ TITLE: ______________

E-MAIL: __________________________________ PHONE: _____________________

FULL NAME: _______________________________ RELATIONSHIP: ______________

COMPANY: ________________________________ TITLE: ______________

E-MAIL: __________________________________ PHONE: _____________________

MILITARY SERVICE

ARE YOU A VETERAN? ☐ YES X NO

BRANCH: ______National Guard__ RANK AT DISCHARGE: _____E2___________

FROM: _______2020 Feb________ TO: ___Currently______________

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TYPE OF DISCHARGE: _____________________

IF NOT HONORABLE, PLEASE EXPLAIN: ______________________________________

BACKGROUND CHECK CONSENT

IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? X YES ☐ NO

DISCLAIMER

Applicant understands that this is an Equal Opportunity Employer and committed to excellence
through diversity. In order to ensure this application is acceptable, please print or type with the
application being fully completed in order for it to be considered.

Please complete each section EVEN IF you decide to attach a resume.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this
application leads to my eventual employment, I understand that any false or misleading
information in my application or interview may result in my employment being terminated.

SIGNATURE _________________________________ DATE _____3/1/2021_______

PRINT NAME _______Dylan Maldonado_________________

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