130 High Street · San Luis Obispo, CA 93401 · Ph: 805-543-0785 · Fax: 805-543-0852

Job Application

To be considered for employment, please fill out the form below:

Personal Info

First Name Last Name Social Security No.
Present Address City State Zip Code
Permanent Address City State Zip Code
Phone No. Referred By

Employment Desired

Position Date You Can Start Salary Desired
Are You Employed? May We Inquire Of Your Present Employer?

Education History

  Name & Location of School Subject Studied Did You Graduate? Years Attended
Grammar School
High School
College
Trade or Business School

General Info

Subject of Special Study Work or Special Training/Skills
U.S. Military or Naval Service Rank

Former Employers

Date (Month & Year) Name & Address of Employer Salary Position Reason For Leaving

References

Give below the names of (3) persons not related to you, whom you have known at least (1) year.

Name Address Business Years Known

Career History

Please read these instructions carefully before completing the form.

  1. In the Business Experience section, each letter (A, B, C, etc.) corresponds to a specific job. If, for example, your present employer is Acme and you have had three different jobs, each with a different job title with Acme:
    A is Acme, present job
    B is Acme, the next previous job
    C is Acme, the job previous to B
    Please complete a section of this form (A, B, C, etc.) for every job where there was a change in your job title. The only jobs to be grouped would be ones such as a two-year job rotation in a management training program - where the "job" changes every three months but the salary stays basically the same, and the job title is really "management trainee."
  2. Begin with your present, or most recent job, and progress backward in time going from A to B to C, etc.
  3. The form is set up for up to 10 job titles, A-J. If you have had more than 10 jobs, that's okay, but please attach a separate sheet outling those additional jobs formatted like jobs D-J.
  4. For each job you are asked to estimate how your final boss would rate your overall performance on a scale of Excellent, Very Good, Good, Fair, and Poor.

If you are applying for a job with a different company: At an appropriate time (near a job offer) we may ask you to arrange personal reference calls with bosses you've had.

Last Name First Middle
Home Address City State Zip Code Phone #
Business Address City State Zip Code Phone #
Email Address Mobile # Date
Position Applied For Earnings Expected ($)

Business Experience

Please start with your present or most recent position. REMINDER: Do not combine jobs. Fill out a complete section of this form for every job where job title changed.

A.

Firm Address
City State Zip Phone
Type of Business Starting Date (mo/yr) Final (mo/yr)
Title Staff (# of Direct Reports) Total Staff
Salary Starting Final
Base
Bonus
Other
Name of Immediate Supervisor Title

What is your best guess as to how this supervisor would rate your overall performance?

Excellent Very Good Good Fair Poor Impossible to Provide

If rating is impossible to provide, please explain
What do (did) you like most about your job?
What do (did) you least enjoy?

If you are leaving or have left the company, please indicate your motivation to leave

100% Mine Mutual 100% Company's (I was fired) Options don't fit circumstance

If options don't fit circumstance, please explain
Reason(s) for leaving

B.

Firm Address
City State Zip Phone
Type of Business Starting Date (mo/yr) Final (mo/yr)
Title Staff (# of Direct Reports) Total Staff
Salary Starting Final
Base
Bonus
Other
Name of Immediate Supervisor Title

What is your best guess as to how this supervisor would rate your overall performance?

Excellent Very Good Good Fair Poor Impossible to Provide

If rating is impossible to provide, please explain
What do (did) you like most about your job?
What do (did) you least enjoy?

If you are leaving or have left the company, please indicate your motivation to leave

100% Mine Mutual 100% Company's (I was fired) Options don't fit circumstance

If options don't fit circumstance, please explain
Reason(s) for leaving

C.

Firm Address
City State Zip Phone
Type of Business Starting Date (mo/yr) Final (mo/yr)
Title Staff (# of Direct Reports) Total Staff
Salary Starting Final
Base
Bonus
Other
Name of Immediate Supervisor Title

What is your best guess as to how this supervisor would rate your overall performance?

Excellent Very Good Good Fair Poor Impossible to Provide

If rating is impossible to provide, please explain
What do (did) you like most about your job?
What do (did) you least enjoy?

If you are leaving or have left the company, please indicate your motivation to leave

100% Mine Mutual 100% Company's (I was fired) Options don't fit circumstance

If options don't fit circumstance, please explain
Reason(s) for leaving

D. - J.

  a. Company
b. City, State
c. Performance Rating (Excellent, Very Good, Good, Fair, Poor)
a. Your title
b. Name of supervisor
c. If left the company after this job, Motivation for Leaving (100% Mine, Mutual, 100% Company's)
a. Date Began (mo/yr)
b. Date Left (mo/yr)
a. Initial Compensation
b. Final Compensation
a. Type of work
D.
   
       
E.
   
       
F.
   
       
G.
   
       
H.
   
       
I.
   
       
J.
   
       

Military Experience

If in service, indicate branch Date (mo/yr) entered Date (mo/yr) discharged
Nature of duties
Highest rank or grade Terminal rank or grade

Education

High School (Highest grade completed)

1 2 3 4

College/Graduate School (Highest grade completed)

1 2 3 4 5 6 7 8

High School

Name of High School Location # in graduating class Rank from top Final GPA
Extracurricular activities
Offices, honors, and awards
Part-time and summer work

College/Graduate School

Name and location Date from Date to Degree Major GPA
Total Credit Hours Extracurricular activies, honors, awards
What undergraduate courses did you like most? Why?
What undergraduate courses did you like least? Why?
How was your education financed?
Part-time and summer work
Other courses, seminars, or studies

Activities

Membership in professional or job-relevant organizations (You may exclude groups that indicate race, color, religion, national origin, disability, or other protected status.
Publications, patents, inventions, professional licences, or additional special honors or awards
What qualifications, abilities, and strong points will help you succeed in this job?
What are your weak points and areas for improvement?

Career Needs

Willing to relocate?

Yes No

If no, explain
Amount of overnight travel acceptable
What are your career objectives?

Other

Do you have the legal right to work for any employer in the U.S.?

Yes No

Would you be willing to arrange reference calls with supervisors you've had in the past decade, as a last step before a final job offer?

Yes No

I certify that answers given in this Glacier Ice SLO Career History Form are true, accurate and complete to the best of my knowledge. I authorize investigation into all statements I have made on this Form as may be necessary for reaching an employment decision. I understand that I may be asked to arrange reference calls with managers I've worked for.

In the event I am employed, I understand that any false or misleading information I knowingly provided in my Career History Form or interview(s) may result in discharge and/or legal action. I understand that if employed, I am required to abide by all rules and regulations of the employer and any special agreements reached between the employer and me.

Signature Date