Last NameFirst NameMiddle Initial
7374 W. Sanna StPeoriaAz85345
Home PhoneCell PhoneE-mail
Birth DateDate AvailableStarting TimeWork History
Begin with your current or most recent position. List each promotion as a separate job.Include paid and voluntary positions. Be as accurate and complete as possible, especially in describing the duties of each position.
Current or Most Recent Position:
Fade Tite Barber ShopReceptionistMay 2010- Nov. 2010
Name of Employer/CompanyJob TitleDates of Employment (From - To)
1712 E. Broadway St.PhoenixAz85040
Employer’s AddressCityStateZip Code
Name of SupervisorHours Per WeekReason for Leaving
Description of Duties:
Greeted Customers; Maintained a Clean Envoironment; Ran Errands For The Employees
Education and Training
Cutting Edge Style AcademyAug 2011- present
Name of CollegeDates Attended-Month/Year
7565 W. Peoria Ave.PeoriaAZ 85345
Peoria High School2009- present
Name of High SchoolDates Attended-Month/Year
11200 N. 83rd AvePeoriaAZ85345
Use this space to identify any career and technical education classes you have received a “C” or better(i.e., Welding, Ag, Media, Culinary, Business Foundations, Life FACS, Drafting, Child Development, etc).
Agricultral Science, Building Trades
List any relevant certificates and licenses (Food Handlers, CPR, etc.), or specialized classes you have taken(i.e., Chemistry, Anatomy, Journalism, Photography, etc.)
Please give any additional information you feel is pertinent that is not listed elsewhere.Do not leave it blank
Dependable, Trustworthy, Helping, Leader, On Time, Reliable
List Three References
Dawn Davis11200 N. 83rd Ave.PeoriaAz85345623-215-5988
Reference #1:List nameAddressCityStateZip CodePhone Number
Jan Delgado11200 N. 83rd Ave.PeoriaAz85345602-290-3628
Reference #2:List nameAddressCityStateZip CodePhone Number
Cecilla Salazar7565 W. Peoria Ave.PeoriaAz85345623-979-9883
Reference #3:List nameAddressCityStateZip CodePhone Number
Signature:By signing this application, you are certifying that the information is true and complete to the best of your knowledge.Unsigned applications will not be considered.
For Internal Use Only
rStudent has been accepted into the work-based learning program.
rStudent has NOT been accepted into the work-based learning program.
__________________________________________________________________________________________________________________________Work--Based Learning Coordinator SignatureDate