SEGUES Employment Application

Part-Time Senior Move Specialists

Cover Letter

Please use this space to type your cover letter.

Applicant Information


Last Name

First Name

MI
 
MM / 

DD /

YY
In the event you are called for an interview, your social security number must be supplied at that time.

Street Address

Apt/Unit

City

State

Zip Code

Please provide your date of birth.

   
MM / 

DD /

YY
Phone Email

Date Available Desired Salary $USD
Position Applied For

Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
If yes, when?
Have you ever been convicted of a felony?
If yes, please explain.

Education


High School

City
From
 
MM / 

DD /

YY
 To
 
MM / 

DD /

YY

  Did you graduate?



College

City

Degree
From
 
MM / 

DD /

YY
 To
 
MM / 

DD /

YY

  Did you graduate?



Other Schooling

City

Degree
From
 
MM / 

DD /

YY
 To
 
MM / 

DD /

YY

  Did you graduate?

References

Please list three professional references.
Reference 1

Full Name

Relationship (i.e. previous supervisor)

Company

Phone

Street Address

City

State

Zip Code
Reference 2

Full Name

Relationship (i.e. previous supervisor)

Company

Phone

Street Address

City

State

Zip Code
Reference 3

Full Name

Relationship (i.e. previous supervisor)

Company

Phone

Street Address

City

State

Zip Code

Previous Employment

Employer 1

Company

Phone

Street Address

Supervisor

Job Title
$ USD
Starting Salary
$ USD
Ending Salary

Responsibilities
From
 
MM / 

DD /

YY
 To
 
MM / 

DD /

YY
 

Reason for Leaving
May we contact your previous supervisor for a reference?
Employer 2

Company

Phone

Street Address

Supervisor

Job Title
$ USD
Starting Salary
$ USD
Ending Salary

Responsibilities
From
 
MM / 

DD /

YY
 To
 
MM / 

DD /

YY
 

Reason for Leaving
May we contact your previous supervisor for a reference?
Employer 3

Company

Phone

Street Address

Supervisor

Job Title
$ USD
Starting Salary
$ USD
Ending Salary

Responsibilities
From
 
MM / 

DD /

YY
 To
 
MM / 

DD /

YY
 

Reason for Leaving
May we contact your previous supervisor for a reference?

Special Skills and Qualifications

Summarize your special skills or qualifications as they are related to the job for which you are applying.

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.


Signature (please type your name)

Date