Montoya

EMPLOYMENT / JOB APPLICATION
PERSONAL INFORMATION
FULL NAME: _Leslie_____Alejandra_____Montoya____DATE_September 28, 2020_

First Middle Last
ADDRESS: __36 Bradford Dr SW________________________________

Street Address Apt/Suite
__Cartersville______Georgia______________30120__________
City State Zip Code
E-MAIL: [email protected]_________ PHONE: _(404) 951- 2038___
SOCIAL SECURITY NUMBER (SSN): _____-____-_____
DATE AVAILABLE: __________________ DESIRED PAY: $_________ ☐ HOUR ☐ SALARY
POSITION APPLIED FOR: _________________________________________________
EMPLOYMENT DESIRED: ☐ FULL-TIME ☐ PART-TIME ☐ SEASONAL
EMPLOYMENT ELIGIBILITY
ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO*
HAVE YOU EVER WORKED FOR THIS EMPLOYER? ☐ YES* ☐ NO
*IF YES, WRITE THE START AND END DATES: ____________________________________
HAVE YOU EVER BEEN CONVICTED OF A FELONY? ☐ YES* ☐ NO
*IF YES, PLEASE EXPLAIN: ____________________________________________________
EDUCATION
HIGH SCHOOL: __Woodland High School___ CITY / STATE: __Cartersville, Georgia__
FROM: ___2016_______ TO: ___2021______
GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________
COLLEGE: _____________________ CITY / STATE: _____________________
FROM: _____________________ TO: _____________________
GRADUATE? ☐ YES ☐ NO DEGREE: _____________________
OTHER: _Bartow County College and Career_ CITY / STATE: __Cartersville, Georgia___
Page 1 of 4
FROM: __2017___________ TO: ____2021________
DEGREE/CERTIFICATION: _CPR and Stop the Bleed__
OTHER: _____________________ CITY / STATE: _____________________
FROM: _____________________ TO: _____________________
DEGREE/CERTIFICATION: _____________________
PREVIOUS EMPLOYMENT
EMPLOYER 1: __Pak-hub__________________________________________
Company / Individual
E-MAIL: __________________________________ PHONE: __(770) 272-2017____
ADDRESS: __127 Riverside Dr SW______________________________________

_Cartersville_______Georgia____________30120______
City State Zip Code
STARTING PAY: $__11___ ☐ HOUR ☐ SALARY ENDING PAY: $___11__ ☐ HOUR ☐ SALARY
JOB TITLE: ______________ RESPONSIBILITIES: __place bottles in machines___
FROM: ______ TO: _____________________
REASON FOR LEAVING: __machines kept breaking down_____________________________

EMPLOYER 2: __________________________________________________________
E-MAIL: __________________________________ PHONE: _____________________
ADDRESS: ____________________________________________________________
____________________________________________________________
City State Zip Code
STARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY
JOB TITLE: ______________ RESPONSIBILITIES: _____________________________
FROM: _____________________ TO: _____________________
REASON FOR LEAVING: _______________________________________________________
EMPLOYER 3: __________________________________________________________
Page 2 of 4
E-MAIL: __________________________________ PHONE: _____________________
ADDRESS: ____________________________________________________________
____________________________________________________________
City State Zip Code
STARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY
JOB TITLE: ______________ RESPONSIBILITIES: _____________________________
FROM: _____________________ TO: _____________________
REASON FOR LEAVING: _______________________________________________________
REFERENCES
(PROFESSIONAL ONLY)
FULL NAME: _______________________________ RELATIONSHIP: ______________

First Last
COMPANY: ________________________________ TITLE: ______________
E-MAIL: __________________________________ PHONE: _____________________

First Last
COMPANY: ________________________________ TITLE: ______________
E-MAIL: __________________________________ PHONE: _____________________

First Last
COMPANY: ________________________________ TITLE: ______________
E-MAIL: __________________________________ PHONE: _____________________
MILITARY SERVICE
ARE YOU A VETERAN? ☐ YES ☐ NO
BRANCH: _____________________ RANK AT DISCHARGE: _____________________
FROM: _____________________ TO: _____________________
Page 3 of 4
TYPE OF DISCHARGE: _____________________
IF NOT HONORABLE, PLEASE EXPLAIN: ______________________________________
BACKGROUND CHECK CONSENT
IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? ☐ YES ☐ NO
DISCLAIMER
Applicant understands that this is an Equal Opportunity Employer and committed to excellence
through diversity. In order to ensure this application is acceptable, please print or type with the
application being fully completed in order for it to be considered.
Please complete each section EVEN IF you decide to attach a resume.
I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this
application leads to my eventual employment, I understand that any false or misleading
information in my application or interview may result in my employment being terminated.
SIGNATURE ___Leslie Montoya__________ DATE ____28 September 2020_____
PRINT NAME ____Leslie Montoya______________
Page 4 of 4

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EMPLOYMENT / JOB APPLICATION

FULL NAME: _Leslie_____Alejandra_____Montoya____DATE_September 28, 2020_

ADDRESS: __36 Bradford Dr SW________________________________

E-MAIL: [email protected]_________ PHONE: _(404) 951- 2038___

SOCIAL SECURITY NUMBER (SSN): _____-____-_____

DATE AVAILABLE: __________________ DESIRED PAY: $_________ ☐ HOUR ☐ SALARY

POSITION APPLIED FOR: _________________________________________________

EMPLOYMENT DESIRED: ☐ FULL-TIME ☐ PART-TIME ☐ SEASONAL

ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO*

HAVE YOU EVER WORKED FOR THIS EMPLOYER? ☐ YES* ☐ NO

*IF YES, WRITE THE START AND END DATES: ____________________________________

HAVE YOU EVER BEEN CONVICTED OF A FELONY? ☐ YES* ☐ NO

*IF YES, PLEASE EXPLAIN: ____________________________________________________

HIGH SCHOOL: __Woodland High School___ CITY / STATE: __Cartersville, Georgia__

FROM: ___2016_______ TO: ___2021______

GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________

COLLEGE: _____________________ CITY / STATE: _____________________

FROM: _____________________ TO: _____________________

GRADUATE? ☐ YES ☐ NO DEGREE: _____________________

DEGREE/CERTIFICATION: _CPR and Stop the Bleed__

OTHER: _____________________ CITY / STATE: _____________________

FROM: _____________________ TO: _____________________

E-MAIL: __________________________________ PHONE: __(770) 272-2017____

ADDRESS: __127 Riverside Dr SW______________________________________

JOB TITLE: ______________ RESPONSIBILITIES: __place bottles in machines___

FROM: ______ TO: _____________________

REASON FOR LEAVING: __machines kept breaking down_____________________________

E-MAIL: __________________________________ PHONE: _____________________

JOB TITLE: ______________ RESPONSIBILITIES: _____________________________

FROM: _____________________ TO: _____________________

REASON FOR LEAVING: _______________________________________________________

JOB TITLE: ______________ RESPONSIBILITIES: _____________________________

FROM: _____________________ TO: _____________________

REASON FOR LEAVING: _______________________________________________________

FULL NAME: _______________________________ RELATIONSHIP: ______________

COMPANY: ________________________________ TITLE: ______________

E-MAIL: __________________________________ PHONE: _____________________

FULL NAME: _______________________________ RELATIONSHIP: ______________

COMPANY: ________________________________ TITLE: ______________

E-MAIL: __________________________________ PHONE: _____________________

FULL NAME: _______________________________ RELATIONSHIP: ______________

COMPANY: ________________________________ TITLE: ______________

E-MAIL: __________________________________ PHONE: _____________________

ARE YOU A VETERAN? ☐ YES ☐ NO

BRANCH: _____________________ RANK AT DISCHARGE: _____________________

FROM: _____________________ TO: _____________________

IF NOT HONORABLE, PLEASE EXPLAIN: ______________________________________

BACKGROUND CHECK CONSENT

IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? ☐ YES ☐ NO

Please complete each section EVEN IF you decide to attach a resume.

SIGNATURE ___Leslie Montoya__________ DATE ____28 September 2020_____

PRINT NAME ____Leslie Montoya______________

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FULL NAME: _Leslie___Alejandra_Montoya__DATE_September 28, 2020_

ADDRESS: 36 Bradford Dr SW______________________________

SOCIAL SECURITY NUMBER (SSN): _--_

DATE AVAILABLE: __________ DESIRED PAY: $_ ☐ HOUR ☐ SALARY

HIGH SCHOOL: Woodland High School_ CITY / STATE: Cartersville, Georgia

FROM: _2016___ TO: _2021______

COLLEGE: _ CITY / STATE: _

FROM: _ TO: _

OTHER: _ CITY / STATE: _

FROM: _ TO: _

E-MAIL: ____________________________ PHONE: (770) 272-2017

ADDRESS: 127 Riverside Dr SW____________________________________

JOB TITLE: __________ RESPONSIBILITIES: place bottles in machines_

FROM: TO: _______________

REASON FOR LEAVING: machines kept breaking down___________________________

E-MAIL: ______________ PHONE: _

JOB TITLE: RESPONSIBILITIES: _______________

FROM: _ TO: _

JOB TITLE: RESPONSIBILITIES: _______________

FROM: _ TO: _

FULL NAME: _________________ RELATIONSHIP:

COMPANY: __________________ TITLE:

E-MAIL: ______________ PHONE: _

FULL NAME: _________________ RELATIONSHIP:

COMPANY: __________________ TITLE:

E-MAIL: ______________ PHONE: _

FULL NAME: _________________ RELATIONSHIP:

COMPANY: __________________ TITLE:

E-MAIL: ______________ PHONE: _

BRANCH: _ RANK AT DISCHARGE: _

FROM: _ TO: _

SIGNATURE _Leslie Montoya____ DATE 28 September 2020_

PRINT NAME Leslie Montoya__________