Application

UM-Flint English-345
Technical Writing Department

Name (last) Name (middle) Name (first)

Smith Terri Gena

Address: 600 State Road

City, State, Zip Code: Flint, MI 48502

Telephone Number: (810) 333-3100

Age Birthdate Citizenship

48 07/10/1947 U S Citizens  Yes 

No

Have you previously

worked for this company? Month [ ] Date [ ] Year [ ]

Please list criminal history:

Date: __________________ _______________________

Criminal Background
___________________________________________

Date: __________________ _______________________

___________________________________________

EMPLOYER #1 ADDRESS CITY, State, Zip

Walmart Corporate Office 3000 Ash Road Lapeer, MI

Date of Employment Month [ August ] Date [ 15th] Year [2000]

(beginning)

Date of Employment Month [September] Date [29] Year [2009]

(ending)
Supervisor’s Name, Title John Walsh, Director of Operations

Telephone Number (810) 762-3100

Job Title: Receptionist

Answered the telephones, directed incoming walk-ins

and customers. Opened the mail, filed
correspondence and processed requests made by the
Job Duties maintenance departments. Other duties as specified
by supervisor.

Application Signature: _______________________________________________

_______________
Date
EMPLOYER #2 ADDRESS CITY, State, Zip

Clinton Construction 2005 W. Village Grand Blanc, MI

Date of Employment Month [ January ] Date [ 1 ] Year [1998]

(beginning)

Date of Employment Month [July ] Date [23 ] Year [2000]

(ending)

Supervisor’s Name, Title Cindy Appleton, Assistant Manager, Purchasing

Telephone Number (810) 667-333

Job Title: Clerk

Answered the telephones, directed incoming walk-ins

and customers. Opened the mail, filed
correspondence and processed requests made by the
Job Duties maintenance departments. Other duties as specified
by supervisor.

EMPLOYER #3 ADDRESS CITY, State, Zip

Date of Employment Month [ ] Date [ ] Year [ ]

(beginning)

Date of Employment Month [ ] Date [ ] Year [ ]

(ending)

Supervisor’s Name, Title

Telephone Number

Job Title:

Job Duties
EMPLOYER #4 ADDRESS CITY, State, Zip

Date of Employment Month [ ] Date [ ] Year [ ]

(beginning)

Date of Employment Month [ ] Date [ ] Year [ ]

(ending)

Supervisor’s Name, Title

Telephone Number

Job Title:

Job Duties

EDUCATION (High School) Address Diploma

South Regional 300 S. Michigan Yes, 1998

College Education Month [ ] Date [ ] Year [ ]

Date of Employment Month [ ] Date [ ] Year [ ]

Technical School

Skills:

Other abilities

Applicant Signature: _____________________________

Date: _________________________________________