Employment / Job Application

EMPLOYMENT / JOB APPLICATION
PERSONAL INFORMATION
FULL NAME: Skylar Hope Nachamkin DATE: 28 September 2020

First Middle Last
ADDRESS: 111 Aztec Way SE

Street Address Apt/Suite
Acworth GA 30102
City State Zip Code
E-MAIL:_skylarnachamkin23@gmail.com PHONE: 6785314588
SOCIAL SECURITY NUMBER (SSN): _____-____-_____
DATE AVAILABLE: 28 September 2020 DESIRED PAY: $25 ☐ HOUR ☐ SALARY
POSITION APPLIED FOR: Registered Nurse
EMPLOYMENT DESIRED: ☐ FULL-TIME ☐ PART-TIME ☐ SEASONAL
EMPLOYMENT ELIGIBILITY
ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO*
HAVE YOU EVER WORKED FOR THIS EMPLOYER? ☐ YES* ☐ NO
*IF YES, WRITE THE START AND END DATES: ____________________________________
HAVE YOU EVER BEEN CONVICTED OF A FELONY? ☐ YES* ☐ NO
*IF YES, PLEASE EXPLAIN: ____________________________________________________
EDUCATION
HIGH SCHOOL: Woodland CITY / STATE: Cartersville, GA
FROM: 2017 TO: 2021
GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________
COLLEGE: Georgia Highlands CITY / STATE: Cartersville,GA
FROM: 2021 TO: 2025
GRADUATE? ☐ YES ☐ NO DEGREE: Bachelors of Nursing
OTHER: _____________________ CITY / STATE: _____________________
Page 1 of 4
FROM: _____________________ TO: _____________________
DEGREE/CERTIFICATION: _____________________
OTHER: _____________________ CITY / STATE: _____________________
FROM: _____________________ TO: _____________________
DEGREE/CERTIFICATION: _____________________
PREVIOUS EMPLOYMENT
EMPLOYER 1: Precision Tune Auto Care

_________________________________________________________
Company / Individual
E-MAIL: ________________________ PHONE: 7709538953
ADDRESS: 1775 Cobb Parkway se A

_Marietta GA 30060
City State Zip Code
STARTING PAY: $8 ☐ HOUR ☐ SALARY ENDING PAY $ 8 ☐ HOUR ☐ SALARY
JOB TITLE: Oil Bay Tech RESPONSIBILITIES: Change oil and keep bay clean
FROM: 2018 TO: 2021
REASON FOR LEAVING: I Started college

EMPLOYER 2: Waffle House
E-MAIL: __________________________________ PHONE: (678) 574-6997

ADDRESS: 1133 GA-92,
Acworth GA 30102
City State Zip Code
STARTING PAY: $7.25☐ HOUR ☐ SALARY ENDING PAY: $7.25☐ HOUR ☐ SALARY
JOB TITLE: Door Corp RESPONSIBILITIES: greet everyone and keep restaurant clean
FROM: 2018 TO: 2020
REASON FOR LEAVING: I was sexually harassed by a customer
EMPLOYER 3: __________________________________________________________
Page 2 of 4
E-MAIL: __________________________________ PHONE: _____________________
ADDRESS: ____________________________________________________________
____________________________________________________________
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: Tony Dutra RELATIONSHIP: 1st Boss

First Last
COMPANY: Precision Tune Auto Care TITLE: owner
E-MAIL: __________________________________ PHONE: _____________________
FULL NAME: Keith Nation RELATIONSHIP: 2nd Boss

First Last
COMPANY: Waffle House TITLE: District Manager
E-MAIL: __________________________________ PHONE: _____________________
FULL NAME: _______________________________ RELATIONSHIP: ______________

First Last
COMPANY: ________________________________ TITLE: ______________
E-MAIL: __________________________________ PHONE: _____________________
MILITARY SERVICE
ARE YOU A VETERAN? ☐ YES ☐ NO
BRANCH: _____________________ RANK AT DISCHARGE: _____________________
FROM: _____________________ TO: _____________________
Page 3 of 4
TYPE OF DISCHARGE: _____________________
IF NOT HONORABLE, PLEASE EXPLAIN: ______________________________________
BACKGROUND CHECK CONSENT
IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? ☐ 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 Skylar Nachamkin DATE 28 September 2020
PRINT NAME: Skylar Nachamkin
Page 4 of 4

Employment / Job Application

Uploaded by

Copyright:

Available Formats

Employment / Job Application

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Employment / Job Application

Uploaded by

Copyright:

Available Formats

EMPLOYMENT / JOB APPLICATION

FULL NAME: Skylar Hope Nachamkin DATE: 28 September 2020

ADDRESS: 111 Aztec Way SE

E-MAIL:_skylarnachamkin23@gmail.com PHONE: 6785314588

SOCIAL SECURITY NUMBER (SSN): _____-____-_____

DATE AVAILABLE: 28 September 2020 DESIRED PAY: $25 ☐ HOUR ☐ SALARY

POSITION APPLIED FOR: Registered Nurse

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

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

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

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

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

*IF YES, PLEASE EXPLAIN: ____________________________________________________

HIGH SCHOOL: Woodland CITY / STATE: Cartersville, GA

FROM: 2017 TO: 2021

GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________

COLLEGE: Georgia Highlands CITY / STATE: Cartersville,GA

FROM: 2021 TO: 2025

GRADUATE? ☐ YES ☐ NO DEGREE: Bachelors of Nursing

OTHER: _____________________ CITY / STATE: _____________________

OTHER: _____________________ CITY / STATE: _____________________

FROM: _____________________ TO: _____________________

EMPLOYER 1: Precision Tune Auto Care

E-MAIL: ________________________ PHONE: 7709538953

ADDRESS: 1775 Cobb Parkway se A

STARTING PAY: $8 ☐ HOUR ☐ SALARY ENDING PAY $ 8 ☐ HOUR ☐ SALARY

FROM: 2018 TO: 2021

REASON FOR LEAVING: I Started college

E-MAIL: __________________________________ PHONE: (678) 574-6997

FROM: 2018 TO: 2020

REASON FOR LEAVING: I was sexually harassed by a customer

JOB TITLE: ______________ RESPONSIBILITIES: _____________________________

FROM: _____________________ TO: _____________________

REASON FOR LEAVING: _______________________________________________________

FULL NAME: Tony Dutra RELATIONSHIP: 1st Boss

COMPANY: Precision Tune Auto Care TITLE: owner

E-MAIL: __________________________________ PHONE: _____________________

FULL NAME: Keith Nation RELATIONSHIP: 2nd Boss

COMPANY: Waffle House TITLE: District Manager

E-MAIL: __________________________________ PHONE: _____________________

FULL NAME: _______________________________ RELATIONSHIP: ______________

COMPANY: ________________________________ TITLE: ______________

E-MAIL: __________________________________ PHONE: _____________________

ARE YOU A VETERAN? ☐ YES ☐ NO

BRANCH: _____________________ RANK AT DISCHARGE: _____________________

FROM: _____________________ TO: _____________________

IF NOT HONORABLE, PLEASE EXPLAIN: ______________________________________

BACKGROUND CHECK CONSENT

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

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

SIGNATURE Skylar Nachamkin DATE 28 September 2020

PRINT NAME: Skylar Nachamkin

You might also like

SOCIAL SECURITY NUMBER (SSN): _--_

OTHER: _ CITY / STATE: _

OTHER: _ CITY / STATE: _

FROM: _ TO: _

JOB TITLE: RESPONSIBILITIES: _______________

FROM: _ TO: _

E-MAIL: ______________ PHONE: _

E-MAIL: ______________ PHONE: _

FULL NAME: _________________ RELATIONSHIP:

COMPANY: __________________ TITLE:

E-MAIL: ______________ PHONE: _

BRANCH: _ RANK AT DISCHARGE: _

FROM: _ TO: _