Name:__________________________
Social Security Number:___________________________
EMPLOYMENT HISTORY
Describe your work experience in detail, beginning with your current or most recent job. Include military service (indicate
rank) and volunteer work. List each promotion or transfer as a separate job, even if they were with the same employer. If
needed, attach additional copies of this page. All information in this section must be completed. Resumes cannot be
used as a substitute for the completed application. Employers and supervisors may be contacted regarding your
work experience.
----------------------------------------------------------------------------------------------------------------------------------------------------------------
Employer’s Name and Address _______________________________________________________________________
Exact Title of Your Position___________________________________________________________________________
From (Month/Year) _______________
To (Month/Year) _____________
Average Hours Per Week ____________
Duties (Be specific - attach extra signed and dated sheets, if necessary): ______________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Approximate Ending Salary ___________
Supervisor’s Name and Title____________________________________
Number and Occupation of Employees you Supervised ____________________________________________________
Reason for Leaving ________________________________________________________________________________
----------------------------------------------------------------------------------------------------------------------------------------------------------------
Employer’s Name and Address _______________________________________________________________________
Exact Title of Your Position___________________________________________________________________________
From (Month/Year) _______________
To (Month/Year) _____________
Average Hours Per Week ____________
Duties (Be specific - attach extra signed and dated sheets, if necessary): ______________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Approximate Ending Salary ___________
Supervisor’s Name and Title____________________________________
Number and Occupation of Employees you Supervised ____________________________________________________
Reason for Leaving ________________________________________________________________________________
----------------------------------------------------------------------------------------------------------------------------------------------------------------
________________________________________________________________________________________________
Sign Your Name Here
Date
Page 4 of 4