WMHC Job Application

Applying For:

Job Title or Announcement #

Contact Info:

Last Name First Name Middle Initial Street City County State Zip Home Phone Work Phone Email

Do You Have a High School Diploma or GED?
Yes No

If not, what is the highest grade you completed? School Address (City/State) Date Attended From: Date Attended To: Major course of study:

College and Graduate School Education

School #1

Name/Location of School: Dates Attended: Major: # of Credits: Type of Degree:

Degree Earned (Y/N):
Yes No

School #2

Name/Location of School: Dates Attended: Major: # of Credits: Type of Degree:

Degree Earned (Y/N):
Yes No

Work Experience

Job #1

Name of Employer: Employers Address: Type of Business: Supervisor's Name & Phone Number: Your Job Title:

Do You Supervise Other Employees?
Yes No

Job Titles of Employees You Supervise Dates of Employment

Is your position full-time? Yes No

How many hours do you work per week? Job Duties

Job #2

Name of Employer: Employers Address: Type of Business: Supervisor's Name & Phone Number: Your Job Title:

Do You Supervise Other Employees?
Yes No

Job Titles of Employees You Supervise Dates of Employment

Is your position full-time? Yes No

How many hours do you work per week? Job Duties

Job #3

Name of Employer: Employers Address: Type of Business: Supervisor's Name & Phone Number: Your Job Title:

Do You Supervise Other Employees?
Yes No

Job Titles of Employees You Supervise Dates of Employment

Is your position full-time? Yes No

How many hours do you work per week? Job Duties

Job #4

Name of Employer: Employers Address: Type of Business: Supervisor's Name & Phone Number: Your Job Title:

Do You Supervise Other Employees?
Yes No

Job Titles of Employees You Supervise Dates of Employment

Is your position full-time? Yes No

How many hours do you work per week? Job Duties

Job #5

Name of Employer: Employers Address: Type of Business: Supervisor's Name & Phone Number: Your Job Title:

Do You Supervise Other Employees?
Yes No

Job Titles of Employees You Supervise Dates of Employment Is your position full-time? Yes No How many hours do you work per week? Job Duties

Have you ever been convicted of any violation of law other than a minor traffic violation?
Yes No

If yes, give the date, place of conviction, charge and disposition of each case. Note: A conviction record will not necessarily bar you from employment.