1. 1
Employment Application
Applicant Information
Full Name: Avey Carly N Date:05/13/15
Last First M.I.
Address: 6210 N. Lincoln
Street Address Apartment/Unit #
Spokane WA 99205
City State ZIP Code
Phone: (509) 607-5345 Email Mdavey112@outlook.com
Date Available: 05/13/15 Social Security No.: Desired Salary:$ 10.00
Position Applied for: Receptionist
Are you a citizen of the United States?
YES NO
If no, are you authorized to work in the U.S.?
YES NO
Have you ever worked for this company?
YES NO
If yes, when?
Have you ever been convicted of a felony?
YES NO
If yes, explain:
Education
High School: Mt. Spokane High School Address:6015 E Mt Spokane Park Dr, Mead, WA 99021
From: 2009 To:2013 Did you graduate?
YES NO
Diploma::
College: Spokane FallsCommunity College Address:3410 W Fort George Wright Dr, Spokane, WA 99224
From: 2013 To:2015 Did you graduate?
YES NO
Degree:
Other: Address:
From: To: Did you graduate?
YES NO
Degree:
References
Please list three professional references.
Full Name: Cayleigh Muller Relationship: Co worker
Company: KinderCare Phone: (509) 499-5821
Address:
Full Name: Daniel Colyar Relationship: Former Boss

2. 2
Company: Colonial Clinic Phone:(509) 467-2854
Address:
Full Name: Josh Phillips Relationship: Friend
Company: Phone: (509) 499-3258
Address:
Previous Employment
Company: Colonial Clinic Phone: (509) 327-9831
Address: 910 N Washington St #210, Spokane, WA 9920 Supervisor: Terri Pratt
Job Title: Receptionist Starting Salary:$ 10.50 Ending Salary:$ 10.50
Responsibilities:
Scheduling appointments, answering the phone, making copies, organizing files, greeting
clients.
From: June 2012 To: August 2012 Reason for Leaving: Summer Job
May we contact your previous supervisor for a reference?
YES NO
Company: KinderCare Learning Center Phone:(509) 467-3112
Address:
610 West Shasta Way Spokane WA 99208
Supervisor: Jenn Starks
Job Title: Infant Teacher Starting Salary:$ 9.45 Ending Salary:$ 9.45
Responsibilities: Taking care of the infants, working well with coworkers, documenting activities
From:
September
2014 To: Current Reason for Leaving:
May we contact your previous supervisor for a reference?
YES NO
Company: Phone:
Address: Supervisor:
Job Title: Starting Salary:$ Ending Salary:$
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference?
YES NO

3. 3
Military Service
Branch: From: To:
Rank at Discharge: Type of Discharge:
If other than honorable, explain:
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: Carly Avey Date: 5/13/15