Serras Senior Transitions Job Application

First Name: Middle initial: Last Name:


City : State: Zip:



Data availiable to start working:

Social Security Number:

Driver License number:

Do you have your own reliable transpotation? Yes No

Do you have the ability to send and recieve emails and text messages? Yes No

Are you currently employed / working? Yes No

Do you have any physical limitation that may prohibit you from moving / lifting? Yes No

If Yes , please explain:

Are you United State Citizen? Yes No

If not, are you legally allowed to work in the United States? Yes No

Have you ever plead "guilty", "no contest", or been convicted of a crime? Yes No

If Yes , please explain:

(Answering yes to this question does not mean you will be automatically rejected for employement. Date of the offense, serriousness and nature of the voilation, rehabilation and position applied for will be considered)

I certify that my answers are true and complete the best of my knowledge. In the event I am employed, i understand that false or misleading information given in my applicationor interview may result in discharge.

Once your application is recieved , we will contact you to set up an interview.