The document is a master application worksheet for an individual seeking employment. It contains personal information, references, work history from three previous jobs, education history, training certificates, skills, and career and educational goals. The work history details jobs as a cashier at Home Depot and Walmart as well as an assistant manager position. The educational background includes graduating from high school and completing some college courses with a goal of becoming a medical assistant.

1. MASTER APPLICATION WORKSHEET
The purpose of the Master Application is to have all of your contact information, education, and
skills in one document. Use this document to assist you in completing employment applications.
Personnel Information
Full Name:
JODIE GOSS
Address:
6850 S 600 W HYRUM UTAH 84319
Home Phone:
435-245-4517
E-mail Address:
Jodie.goss@aol.com
Cell Phone:
435-225-3857
Are you a veteran? Yes No no
Have you ever been convicted of a
misdemeanor or felony?
YES
If yes, Please explain:
PLEASE ASK ME
References:
Name: Address E-mail Address Phone
KATHIE TAYLOR 626 N 80 W #3
LOGAN UT 84321
KATAYLOR79@YAHOO.COM 435-890-5389
TANISHA PARKER 725 S RIVERWALK
#235
LOGAN UT 84321
PARKER_TANISHA@YAHOO.COM 435-314-9622
CHEYANNE KIRBY 244 W ONEIDA
PRESTON IDAHO
83263
CHEYANNEK@YAHOO.COM 402-765-1142
JEREMIAH
MAUGHAN
1693 N 400 E
BUILDING G APT
103
LOGAN UTAH 84321
JEREMAUGH@YAHOO.COM 435-799-1263
Work Experience
Start with your most recent job and work back. Unpaid positions can be considered work
experience.
1) Work History
Job Title:
CASHIER
Company Name and Address:
HOME DEPOT
130 CACHE VALLEY BLVD
LOGAN UTAH 84341
Dates: From 15/08/2006to 01/01/2008 Salary: Starting $8.00 Ending $10.00
1

2. Supervisor’s Name:
BECKI CHILDS
Supervisor’s Phone #:
435-787-2657
Supervisor’s e-mail address: May we contact this employer:
YES
Description of Duties, tasks and accomplishments:
• STOCKING
• RUN CASH REGISTER
• CUSTOMER SERVICE
Honors/ Awards:
• REICIEVED 6 AWARDS FOR GREAT CUSTOMER SERVICE AND CASHIERING
• WON SECOND IN A CASHIER COMPITITION
Special Courses taken (Seminars, workshops, training programs):
• XXX
Reason for Leaving this job?
MOVED OUT OF STATE TO GET MARRIED
What did you dislike about this job?
NOTHING
What did you like about this job?
EVERYTHING, THE PEOPLE
2. Work History:
Job Title:
TLE TECH
CASHIER
Company Name and Address:
WALMART
1550 N MAIN
NORTH LOGAN UTAH 84341
Dates: From 15/03/2004 to 14/08/2006 Salary: Starting $8.10 Ending $10.50
Supervisor’s Name:
JERRY
Supervisor’s Phone #:
435-753-0880
Supervisor’s e-mail address: May we contact this employer:
YES
Description of Duties, tasks and accomplishments:
• CUSTOMER SERVICE
• MOUNT BALANCE TIRES
• FIX FLAT TIRES
• PERFORM OIL CHANGES
• CASHIER
• INSTALL CAR BATTERIES
Honors/ Awards:
• XXXX
• XXXX
Special Courses taken (Seminars, workshops, training programs):
• XXX
Reason for Leaving this job?
PERSONNAL
2

3. What did you dislike about this job?
TIRES
What did you like about this job?
THE PEOPLE AND THE WORK I DID
3. Work History:
Job Title:
ASSISTANT MANAGER
Company Name and Address:
TRAILSIDE GENERAL STORE
HIGHWAY 89-91 LOGAN UTAH 84319
Dates: From 01/04/1998 to 25/08/2004 Salary: Starting $5.50 Ending $10.00
Supervisor’s Name:
JERRY
Supervisor’s Phone #:
N/A
Supervisor’s e-mail address: May we contact this employer:
NO
Description of Duties, tasks and accomplishments:
• SCHEDULING
• CASHIER
• STOCKING
• ORDERS
• BANK DEPOSITS COUNT DOWN TILLS
Honors/ Awards:
• XXXX
• XXXX
Special Courses taken (Seminars, workshops, training programs):
• XXX
Reason for Leaving this job?
STORE CLOSED
What did you dislike about this job?
NOTHING
What did you like about this job?
EVERYTHING I LOVED THIS JOB
Education and Training
High School, College, Business, Trade Schools
Name Location Major Dates Attended Degree/Certificate
High School
LOGAN HIGH LOGAN UTAH General 1996 Graduate/GED
College
STEPHEN
HENEGERS
LOGAN UTAH MEDICAL 2015 MA
Graduate
3

4. Training
(professional, technical, clerical, management, license, certificate, etc., training programs)
NOTE: Make a separate entry for each training program completed
Name Location Dates Attended Hours/Credits
Completed
Certificate/license
Earned
1) FOOD
HANDLERS
ONLINE 2015 3 FOOD
HANDLERS
PERMIT
Courses Attended:
Special Skills
Skill Fluent Knowledgeable
Foreign Language / American Sign Language
Computer Languages
Skill Expert Knowledge of
Computer Hardware
Computer Software
Skill Operate Repair
Machines / Equipment CASH
REGISTER
FAX
TIRE MACHINE
Skill Proficient Knowledgeable
Clerical Skills COMPUTERS
CASH
REGISTERS
FAX
10 KEY
Career Goals: (Specific, Measurable, Attainable, Realistic, Tractable)
TO GAIN EMPLOYMENT AS A LUBE TECH OR A CASHIER
4

5. Short –Term Occupational Goals
(6 -12 months)
Long Term / retirement goals
(5 – 10 Years)
BECOME AN MA AND START WORKING TOWARD THAT FIELD
Educational Goals
GET MY ASSOCIATES DEGREE IN MEDICAL
Other Information
Hobbies / Interests:
HUNTING, CAMPING ,READING,
Memberships in Organizations
Volunteer/Community Activities
(Duties and Accomplishments)
Publications / Presentations:
Other
5

6. Short –Term Occupational Goals
(6 -12 months)
Long Term / retirement goals
(5 – 10 Years)
BECOME AN MA AND START WORKING TOWARD THAT FIELD
Educational Goals
GET MY ASSOCIATES DEGREE IN MEDICAL
Other Information
Hobbies / Interests:
HUNTING, CAMPING ,READING,
Memberships in Organizations
Volunteer/Community Activities
(Duties and Accomplishments)
Publications / Presentations:
Other
5