920 Black Creek Drive Phone: (209) 785-2688

Copper Cove at Lake Tulloch Owners’ Association

920 Black Creek Drive Phone: (209) 785-2688

Copperopolis, CA 95228 Fax: (209) 785-2698

Website: Email:

Application For Employment

Applicant Information

Full Name:DOB:

LastFirstM.I.

Address:

Street AddressApartment/Unit #

CityStateZip Code

Phone:

Home PhoneCell Phone

Misc Info:

Driver’s License #Social Security #

Are you a citizen of the US? If no, are you authorized to work in the US?

Have you ever worked for this company before? When?

Have you ever been convicted of a felony? If yes, please explain:

Position Applied For: Date Available to Start:

Salary Desired: $ per hour

Education

High School:Address:

From:To:Did you graduate?

College:Address:

From:To:Did you graduate?

Other:Address:

From:To:Did you graduate?

Job History

Please list most recent employer first

Company Name:Phone:

Address:Supervisor:

Job Title:From:To:

Reason for leaving?Salary:

May we contact your previous supervisor for a reference?

Company Name:Phone:

Address:Supervisor:

Job Title:From:To:

Reason for leaving?Salary:

May we contact your previous supervisor for a reference?

Company Name:Phone:

Address:Supervisor:

Job Title:From:To:

Reason for leaving?Salary:

May we contact your previous supervisor for a reference?

Personal References

Please list three personal reference

Full Name:Relationship:

Occupation:Phone:

Address:

Street AddressApt. #CityStateZip Code

Full Name:Relationship:

Occupation:Phone:

Address:

Street AddressApt. #CityStateZip Code

Full Name:Relationship:

Occupation:Phone:

Address:

Street AddressApt. #CityStateZip Code

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this applications leads to my employment by Copper Cove at Lake Tulloch Owners’ Association, I understand that false or misleading information in my application or interview may result in termination. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

My signature on this application certifies that I agree to submit to a pre-employment drug screening.

Applicant’s Signature:Date:

FOR OFFICE USE ONLY:

Interview Date & Time:Hired?Start Date:

Position:Starting Wage: $per hour

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