SEGUES Employment Application
 Part-Time Senior Move Specialists

Cover Letter
Please use this space to type your cover letter.

Applicant Information

Last Name
First Name
MI
 
MM / 
DD /
YY		 In the event you are called for an interview, your social security number must be supplied at that time.

Street Address
Apt/Unit

City
State
Zip Code

Please provide your date of birth.

    
MM / 
DD /
YY
Phone Email
Date Available Desired Salary $USD
Position Applied For
Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
If yes, when?
Have you ever been convicted of a felony?
If yes, please explain.

Education

High School
City
From
 
MM / 
DD /
YY
 To
 
MM / 
DD /
YY

  Did you graduate?

College
City
Degree
From
 
MM / 
DD /
YY
 To
 
MM / 
DD /
YY

  Did you graduate?

Other Schooling
City
Degree
From
 
MM / 
DD /
YY
 To
 
MM / 
DD /
YY

  Did you graduate?

References
Please list three professional references.
Reference 1

Full Name
Relationship (i.e. previous supervisor)

Company
Phone

Street Address

City
State
Zip Code
Reference 2

Full Name
Relationship (i.e. previous supervisor)

Company
Phone

Street Address

City
State
Zip Code
Reference 3

Full Name
Relationship (i.e. previous supervisor)

Company
Phone

Street Address

City
State
Zip Code

Previous Employment
Employer 1

Company
Phone

Street Address
Supervisor

Job Title		 $ USD
Starting Salary		 $ USD
Ending Salary

Responsibilities
From
 
MM / 
DD /
YY
 To
 
MM / 
DD /
YY
 

Reason for Leaving
May we contact your previous supervisor for a reference?
Employer 2

Company
Phone

Street Address
Supervisor

Job Title		 $ USD
Starting Salary		 $ USD
Ending Salary

Responsibilities
From
 
MM / 
DD /
YY
 To
 
MM / 
DD /
YY
 

Reason for Leaving
May we contact your previous supervisor for a reference?
Employer 3

Company
Phone

Street Address
Supervisor

Job Title		 $ USD
Starting Salary		 $ USD
Ending Salary

Responsibilities
From
 
MM / 
DD /
YY
 To
 
MM / 
DD /
YY
 

Reason for Leaving
May we contact your previous supervisor for a reference?

Special Skills and Qualifications
Summarize your special skills or qualifications as they are related to the job for which you are applying.

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.

Signature (please type your name)
Date