Peninsula College

Employment Application | Model

Applicant Information

Full Name: Muka Meskerem Zega Date:2/16/2018

Last First M.I.

Address: 815 Whidbey Ave N/A

Street Address Apartment/Unit #

Port Angeles WA 98362

City State ZIP Code

Phone: 360-808-7006 Email Meskrem911@yahoo.com

Date Available: N/A Social Security No.:389-97-1099 Desired Salary:$3,000

Position Applied for: Accountant or Office Assistant

YES NO YES NO
Are you a citizen of the United States? If no, are you authorized to work in the U.S.?

YES NO
Have you ever worked for this company? If yes, when? N/A

YES NO
Have you ever been convicted of a felony?

If yes, explain: N/A

Education
High School: Ethiopia/high school Address:Dilla

YES NO
From: 1995 To:2002 Did you graduate? Diploma:: Yes

College: Admass College/Ethiopia Address:Addis Ababa

YES NO
From: N/A To:N/A Did you graduate? Degree: N/A

Other: NA Address: N/A

YES NO
From: 2015 To:2018 Did you graduate? Degree: Yes

References
Please list three professional references.

Full Name: Marily Ripley Relationship:AAI Director

Company: Adaption Advocate International Phone:360-460-4878

1
Address: 263 Lake Down RD Port Angeles, WA 98362
Administrative
Full Name: Jan Isett Relationship:assistant
Company: Peninsula college Phone:360-460-8181
Address: 1502 East Lauridsen Boulevard Port Angeles

Full Name: Karin Knight Relationship:Office Manager

Company: Serenity Thrift Store Phone:360-461-3068
th
Address: 2203 West 18 Port Angeles WA 98363

Previous Employment

Company: N/A Phone:N/A

Address: N/A Supervisor:N/A

Job Title: N/A Starting Salary:$N/A Ending Salary:$N/A

Responsibilities: N/A

From: N/A To:N/A Reason for Leaving:N/A

YES NO
May we contact your previous supervisor for a reference?

Company: N/A Phone:N/A

Address: N/A Supervisor:N/A

Job Title: N/A Starting Salary:$N/A Ending Salary:$N/A

Responsibilities: N/A

From: N/A To:N/A Reason for Leaving:N/A

YES NO
May we contact your previous supervisor for a reference?

Company: N/A Phone:N/A

Address: N/A Supervisor:N/A

Job Title: N/A Starting Salary:$N/A Ending Salary:$N/A

Responsibilities: N/A

From: N/A To:N/A Reason for Leaving:N/A

YES NO
May we contact your previous supervisor for a reference?

2
 Military Service

Branch: N/A From:N/A To:N/A

Rank at Discharge: N/A Type of Discharge:N/A

If other than honorable, explain: N/A

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: Meskerem Muka Date: February 16, 2018