High School

Name of School
Location of School
Degree or Course of Study
Dates Completed

College/Trade School

Name of School
Location of School
Degree or Course of Study
Dates Completed

Latest Work Experience

Name of Employer
Telephone Number
Dates Worked
Pay
Job Title
Job Description
Reason For Leaving

Please list any volunteer or community service. NOTE: To place additional rows use the circled plus sign next to the first line.Volunteer/Community Involvement

Name of Organization
Telephone Number
Dates Served
Description of Service

Please list the name of three references whom we may contact who have knowledge of your skills, knowledge, and abilities. PLEASE DO NOT LIST FAMILY MEMBERS. NOTE: Include name, relation to you (teacher, supervisor, etc.), phone number, email (required).

References *

Do you have any physical condition or handicap that may limit your ability to perform the job applied for?

Yes

If yes, what can be done to accommodate your limitation?

Have you been convicted of a felony within the past 15 years?

Yes

* A conviction will not necessarily disqualify you from employment. If yes, please provide a description of rehabilitation/restitution treatment that you have engaged in as a result of that conviction.

Note: If you are hired, you will be required to provide Social Security # and either Birth Certificate or Driver's License before you are scheduled for any hours.Are you legally entitled to work in the U.S?

Yes

Resume

RM Mission Statement Overview *

By checking this box you acknowledge YOU HAVE READ through THE RM MISSION STATEMENT, can discuss it, and are aligned with the workplace culture Refreshing Mountain strives to maintain.