APPLICATION FOR EMPLOYMENT

This generic application is prwided by WorkSource Washington. This form complies with federal and state laws against discrimination;
however, employers using this form should check local ordinances. WorkSource \A/ashington and Washington State Employment Security
are not responsible for the misuse of information provided on this form. Provide all information requested by printing in ink -or typing. Us6
the 'TAB' key to move through lhe document.

GENERAL INFORMATION
Name {Last}

lnitial)

Home Telephone

()

Esmeralda

Address (Mailing Address)

(cilv)

1229 Bennett Way

Sanger

E-Mail Address

esme. munoz2

(fbliddle

{First)

Munoz

{5rare}

CA

(zip)

Other Telephone

93657

(55e)

Are you legally entifled to work in the U.S.?

@gmail.com

yes

Uo

POSTTTON
Position Or Type Of Employment Desired

shift:

Will Accept:
f] Part-time

Any avaiable positions

Are you able to perform the essential functions of the job you are applying for, with or
without reasonable accommodation? X Yes n No

X
fl

X
fl

rulltime

I
[-l

Temporary

Salary Desired

Date Available

Minimum

3122t16

oay
swing
Graveyard

Rotatinc

EDUCATION AND TRAINING

High School Graduate Or General Education (GED) Test passed?
lf no, list the highest grade completed

yes

Ho

Golleg , Business School, Military {ifiost recent firct]

Dates
Name and Location

Attended
Month/Year

Credits Eamed
Quarterly or
Other
Semester
(Specjfu)
Hours

Graduate

fl

Yes

To
From

Yes

From

Degree
& Year

Major
or Subject

tto

nNo

To
From

Ll Yes
nruo

To

From

yes

[]No

To
Occupational License, Certificat or Registration

Numbr

Where lssued

Expiration Date

occupational License, Certificate or Registration

Number

Where lssued

Expiration Date

Occupational License, Certificate or Registration

Number

Where lssued

Expiration Date

Languages Read, Written or Spoken Fluently Other Than English

VETERAN INFORMATION

lAlarrrz {

{B& &Ers-d}

WORK EXPERIENCE

Recent

Employer Herta Farnilv Farms

Address
Job Title Fruit Grader
Specific Duties {Maximum 1000 characters}
I was to grade the

work and
Teleohone Number {559) 638 -

4274

From {Month/Year)

06t2016
To {ilonth/Year)

Number Employees Supervised

48t2016

fruit. I had to evaluate the fruit and if it was good I would pack it, and if not

would dicard that friut.

Hours PerWeek

4A
Last Salary

Minimum
Supervisor
Reason For Leaving Going back to school

Employer
Address
Job Title
Specific Duties (Maximum {000 characters}

May We Contact This Employer?

Telephone Number
N

umber Emplovees Supervised

V"s

f]

uo

From {Month/Year)

To {Month/Year)
Hours PerWeek
Last Salary

Supervisor
Reason For Leaving

Employer
Address
Job Title

Telephone t{umber

llay tffe Contact This Employer? n yes f]

From {MonthiYear}
)

Number Employees Supewised

ruo

To (itlonth/Year)

Specific Duties (Maximum 1000 characters)

Hours PerWeek
Last Salary
Supervisor
Reason For Leaving

Employer
Address
Job Title
Specific Duties (Maximum 1000 characters)

llllay We

Telephone

Number (

Number Employees Supervised

Gonbct This Employer?

fl

Ves

No

From (ilonth/Year)

To (Month/Year)
Hours Per Week
Last Salary

Supervisor
Reason For Leaving
I certify the information contained in this application is true,
statements reported on tfiis application may be

Signature of
I

nterviewef s Comments:

tlayWe Gontact This Employer? f]

Yes

complete. I undestand thaQ if employed, false

for dismissal.
Date

No