APPLICATION FOR EMPLOYMENT

This generic application is provided by WorkSource Washington. This form complies with federal and state laws against discrimination;
however, employers using this form should check local ordinances. WorkSource Washington and Washington State Employment Security
are not responsible for the misuse of information provided on this form. Provide all information requested by printing in ink or typing. Use
the 'TAB' key to move through the document.

GENERAL INFORMATION
Name (Last)

(First)

Nauman

Nicholas

Address (Mailing Address)

(City)

4708 N. Crestmoor Avenue

Clovis

E-Mail Address

(Middle Initial)

A
(State)

CA

(559) 292 - 7119

(Zip)

Other Telephone

93619

(916) 549 - 5430

Are you legally entitled to work in the U.S.?

nnauman56@gmail.com

Home Telephone

Yes

No

POSITION
Position Or Type Of Employment Desired

Open
Are you able to perform the essential functions of the job you are applying for, with or
without reasonable accommodation?
Yes
No
Salary Desired

Will Accept:
Part-Time
Full-Time
Temporary

Shift:
Day
Swing
Graveyard
Rotating

Date Available

Open

EDUCATION AND TRAINING

High School Graduate Or General Education (GED) Test Passed?
If no, list the highest grade completed

Yes

No

College, Business School, Military (Most recent first)

Name and Location

Dates
Attended
Month/Year

Credits Earned
Quarterly or
Other
Semester
(Specify)
Hours

Graduate

From
To
From

Degree
& Year

Major
or Subject

Yes
No
Yes
No

To
From
To
From
To

Yes
No
Yes
No

Occupational License, Certificate or Registration

Number

Where Issued

Expiration Date

Occupational License, Certificate or Registration

Number

Where Issued

Expiration Date

Occupational License, Certificate or Registration

Number

Where Issued

Expiration Date

Languages Read, Written or Spoken Fluently Other Than English

VETERAN INFORMATION (Most recent)

Branch of Service

Date of Entry

Date of Discharge

None

SPECIAL SKILLS (List all pertinent skills and equipment that you can operate)
(Maximum 1000 characters) I

am proficient in using a computer as well as caring for animals. I am also well versed in
warehouse labor, and am able to clean and take inventory on items with ease.

EMS 10171 CC 7540-032 635

ESD 1999 Rev. 12/30/03

WORK EXPERIENCE (Most Recent First)

Employer Janel Hidy
Address 10490 E. Acacia

(Include voluntary work and military experience)

Telephone Number

(559) 292 - 3492

06/2014

Avenue, Clovis CA 93619

Job Title Pet Caretaker

Specific Duties (Maximum 1000 characters)

From (Month/Year)

Number Employees Supervised

To (Month/Year)

Present

Twice a day I fed, walked and cared for Ms. Hidy's family dog. I almost administered his
medication daily. My duties also included taking out their trash for the week and getting their
mail daily.

Hours Per Week

Varies
Last Salary

$15.00 per day

Supervisor

Janel Hidy
Still employed as needed.
Employer Tom and Necia Wollenman
Address /
Job Title Pet Caretaker
Reason For Leaving

May We Contact This Employer?

Telephone Number

(559) 292 - 8825

Yes

No

From (Month/Year)

06/2015
Number Employees Supervised

To (Month/Year)

Specific Duties (Maximum 1000 characters)

Present

Twice a day I fed and cared for the family cat. I also was responsible for checking on the
security of their house twice a day. My duties included taking out their trash and getting their
mail daily.

Hours Per Week

Varies
Last Salary

$20.00 per day

Supervisor

Tom Wollenman
Reason For Leaving

Still employed as needed.

Employer Hodges Electric

Address 1239 Hoblitt Avenue,

May We Contact This Employer?

Telephone Number

(559) 298 - 5533

No

06/2015

Clovis CA 93612

Job Title Warehouse Worker

Specific Duties (Maximum 1000 characters)

Yes

From (Month/Year)

Number Employees Supervised

To (Month/Year)

08/2015

Cleaned the warehouse and the company vans. Took inventory of electrical parts. Organized
the electrical inventory. Cleaned and organized 500 circuit breakers. Dug a trench for irrigation.
Completed various miscellaneous jobs the boss required each day.

Hours Per Week

24
Last Salary

$9.00
Supervisor

Roger Hidy
Summer job. Went back to school.
May We Contact This Employer?
Yes
No
From (Month/Year)
Employer Renae Cowings
Telephone Number (559) 960 - 2381
07/2015
Address 2602 Blackwood Avenue, Clovis CA 93619
To (Month/Year)
Job Title Pet Caretaker
Number Employees Supervised 0
08/2015
Specific Duties (Maximum 1000 characters)
Fed, walked and cared for 6 family pets twice a day. My duties included taking out their trash
Hours Per Week
and getting their mail daily.
Varied
Reason For Leaving

Last Salary

$25.00 per day

Supervisor

Renae Cowings
Reason For Leaving

Summer job. Went back to school.

May We Contact This Employer?

Yes

No

I certify the information contained in this application is true, correct, and complete. I understand that, if employed, false
statements reported on this application may be considered sufficient cause for dismissal.

Signature of Applicant_________________________________________________________ Date________________

Interviewers Comments:

WorkSource Washington and Washington State Employment Security are equal opportunity employers and providers of employment and training services.
Auxiliary aids and services are available to persons with disabilities upon request.