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EMPLOYMENT FORM

Please complete the form below.
Personal Information
Name (Last name first)
Email Address
Present Address   Apt. No. 
City   State    Zip 
Permanent Address   Apt. No. 
City   State    Zip 
Phone No.
Emergency No.
Contact Person
Relationship
Are you 18 years or older? Yes No
Do you hold a current driver's license? Yes No
D/L #   Exp. Date 
State?   Type? 

Desired Employment
Position Applied For
Date you can start   Salary Desired 
Are you employed now? Yes No
May we contact present employer? Yes No
Referred by
Name of last supervisor
Reason for leaving
Ever worked for SMSD before? Yes No
Where?   When? 
Ever applied to SMSD before? Yes No
Where?   When?
Can you travel or relocate, if required? Yes No
Can you provide proof of citizenship or
immigration status on employment?		 Yes No
Do you have relatives working for SMSD? Yes No

Education
Name and Location of Grammar School
Years attend   Year graduated 
Degree/Major or Subjects Studied
Name and Location of High School
Years attend   Year graduate 
Degree/Major or Subjects Studied
Name and Location of College School
Years attend   Year graduated 
Degree/Major or Subjects Studied
Name and Location of Trade School
Years attend   Year graduate 
Degree/Major or Subjects Studied

General
Special Study
Special Training
Special Skills
Professional certificates currently held

Employment History
Employer Name
Starting Date   Leaving Date 
Address
City   State    Zip 
Job title
Starting Salary   Ending Salary 
May we contact your supervisor? Yes No
Name of Supervisor
Title   Phone 
Description of work
Reason for leaving
Employer Name
Starting Date   Leaving Date 
Address
City   State    Zip 
Job title
Starting Salary   Ending Salary 
May we contact your supervisor? Yes No
Name of Supervisor
Title   Phone 
Description of work
Reason for leaving
Employer Name
Starting Date   Leaving Date 
Address
City   State    Zip 
Job title
Starting Salary   Ending Salary 
May we contact your supervisor? Yes No
Name of Supervisor
Title   Phone 
Description of work
Reason for leaving
Employer Name
Starting Date   Leaving Date 
Address
City   State    Zip 
Job title
Starting Salary   Ending Salary 
May we contact your supervisor? Yes No
Name of Supervisor
Title   Phone 
Description of work
Reason for leaving

References
Name
Address
Phone No.   Business 
Name
Address
Phone No.   Business 
Name
Address
Phone No.   Business 
Name
Address
Phone No.   Business 

Millitary Record
Branch of Service
Rank   Years Served 
Date of Discharge   Type of Discharge 
Branch of Service
Rank   Years Served 
Date of Discharge   Type of Discharge 
Branch of Service
Rank   Years Served 
Date of Discharge   Type of Discharge 
 
Have you ever been convicted of a felony? Yes No
If yes, explain (will not necessarily exclude you from consideration)
 
What is your primary language?
What other languages do you speak?
What other languages do you read?
What other languages do you write?