Acme Medical Company

Employment Application
Applicant Information
Full Date
Name: Cason Christopher C : 24 March 2017
Last First M.I.

Address: 1501 Sweetwater Ln

Street Address Apartment/Unit #

North
Raleigh Carolina 27610
City State ZIP Code

Emai
Phone: 765-379-2856 l | CCason1999@gmail.com

Date 28 March Social Security Desired

Available: 2017 No.: Salary: $62,720

Position Applied
for: MRI - Technologist

YE
Are you a citizen of the United YES NO If no, are you authorized to work in the S NO
States? X U.S.?

Have you ever worked for this YES NO If yes,

company? X when?

Have you ever been convicted of a YES NO

felony? X

If yes,
explain:

Education
High Wake Early College Addres
School: Health and Science s: 2901 Holston Ln Raleigh,NC

Did you YES NO Diplom

From: 2013 To: 2017 graduate? X a:: yes

Colleg Addres
e: Johnston Community College s: 245 College Rd, Smithfield, NC 27577

Did you YES NO Degree

From: 2014 To: 2016 graduate? X : Associate Degree

Other Addres
: s:

From: To: Did you YES NO Degree

1
 graduate? :

References
Please list three professional references.
Full Relationshi
Name: Michael Shaw p: Friend
Compan
y: Walgreen Drugs and Pharmacy Phone: 984-257-7685
Address: 3125 Apple Common Dr Raleigh,NC 27614

Full Relationshi
Name: Alesha Pierce p: Friend
Compan
y: Whitley Law Firm Phone: 919-523-7564
Address: 1468 Lake Hills CT Knightdale,NC 27545

Full Relationshi
Name: Nikki Marshall p: Friend
Compan
y: BB&T Bank Phone: 779-646-3684
Address: 1913 Delta river Dr. Raleigh,NC 27612

Previous Employment
Compan
y: Rex HealthCare Phone: (919) 784-3100
Superviso
Address: 4420 Lake Boone Trail, Raleigh, NC 27607 r:

Starting
Job Title: MRI-Tech Salary: $48,902 Ending Salary: $58,675

Responsibiliti
es: X-Ray, Cleaning instruments,Organizing,Working with Patients,

To Reason for
From: 2008 : 2016 Leaving: Trying new Job

May we contact your previous supervisor for a YES NO

reference? X
Yes, you can .

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Compan
y: Phone:
Superviso
Address: r:

Starting
Job Title: Salary: $ Ending Salary: $

Responsibiliti
es:

To Reason for
From: : Leaving:

May we contact your previous supervisor for a YES NO

reference?

Compan
y: Phone:
Superviso
Address: r:

Starting
Job Title: Salary: $ Ending Salary: $

Responsibiliti
es:

To Reason for
From: : Leaving:

May we contact your previous supervisor for a YES NO

reference?

Military Service
Branc
h: From: To:

Rank at Type of
Discharge: Discharge:

If other than honorable,

explain:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my
application or interview may result in my release.
Signatur Date
e: Christopher.Cason : 24 March 2017

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