HomeMy WebLinkAboutReel_0024D (3)
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PRE-EMPLOYHENT APPLICATION
EA/C/AJEE/!./vC. IlSSIs7/I-/LJ r
(Position Applied for)
Jefferson County is an EqualOpportunicy Employer and encourages applications from
all persons regardless of race, creed, color, sex, national origin, marital status, age
or physical, sensory or mental disability unless based upon a bona fide occupational
qualification. (State Law: Chapter 49.60 RCW and WAC 162)
IMPORTANT: Complete all section. Please use ink. Print name only.
2.
Address: 7s1 /lie IlJIINnlV l-/flLL
(street)
1/ I?F i,)
(city)
A {2.LI,J
(middle)
_<,eA7"/LE tJ/kl-l, '18/0s-
(state) (zip)
D.He of Birth: '1/;6-/5(, (age will not
be used to discriminate)
1. Name: BE',<./,vE'-r-r
(last)
STlO:vE
(first)
3.
Social Securi ty No: 53:< - S;? - C:O</{)
4.
5_
7.
Home/Message phone:S<[3- 77SG
6. Business phone:
$An1C
Education -Total years of pre-university schooling:
Circle year completed: 1 2 5 8 9 10 11 @
8. Have your passed the General Education Development (GED) Test in lieu of High School
Gradu3t~ion? Yes_No_Year
9. Colleges attended Years From To Degree
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UAJ#II,c"R" /7"'-" 0;: /.JAq'/I-.Jt'. 'mtJ 77 ;>If) 13Sc.e:-
10. REFERENCES: (please do not list relatives)
NAl1E
ADDln:SS
OFFICE/HOHE PHONE
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4.
5.
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Form 100, n.p.c.c., Rev nee 1974
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