Job Application

EMPLOYMENT / JOB APPLICATION
PERSONAL INFORMATION
FULL NAME: _Sebastian__Antonio______Sosa____ DATE: ___9/28/20__

First Middle Last
ADDRESS: _17 Juliana way________________________________________

Street Address Apt/Suite
_cartersville_________GA___________________30120_____
City State Zip Code
E-MAIL: __Sebastiansosa300@yahoo.com_PHONE: ___678-899-5210__
SOCIAL SECURITY NUMBER (SSN): _____-____-_____
DATE AVAILABLE: 9/28/20____ DESIRED PAY: $_________ ☐ HOUR ☐ SALARY
POSITION APPLIED FOR: General dentist_______________________
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: __Cass high school____ CITY / STATE: __White, GA__
FROM: _____2017_______ TO: ___2021____
GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________
COLLEGE: _______N/A__________ CITY / STATE: _____________________
FROM: _____________________ TO: _____________________
GRADUATE? ☐ YES ☐ NO DEGREE: _____________________
OTHER: _____________________ CITY / STATE: _____________________
Page 1 of 3
FROM: _____________________ TO: _____________________
DEGREE/CERTIFICATION: _____________________
OTHER: _____________________ CITY / STATE: _____________________
FROM: _____________________ TO: _____________________
DEGREE/CERTIFICATION: _____________________
PREVIOUS EMPLOYMENT
EMPLOYER 1: ____La fiesta_________________________________________

Company / Individual
E-MAIL: __________________________________ PHONE: ___ (770) 386-3563
ADDRESS: __ 62 Gilreath Rd SE Ste C ______________________________________

Street Address Apt/Suite
_cartersville________georgia_______________30120______
City State Zip Code
STARTING PAY: $__9__ ☐ HOUR ☐ SALARY ENDING PAY: $___9___ ☐ HOUR ☐ SALARY
JOB TITLE: __warehouse packer___ RESPONSIBILITIES: __ packaging goods, placing

labels on packages and operating warehouse vehicles _
FROM: ____may 6_____ TO: _____july 26_____
REASON FOR LEAVING: _school _
REFERENCES
(PROFESSIONAL ONLY)
FULL NAME: _Harry__________Wyche______ RELATIONSHIP: __Teacher___

First Last
COMPANY: _____BCCA___________ TITLE: _Teacher___
E-MAIL: __________________________________ PHONE: _____________________
FULL NAME: _Bobby___________Hughes____ RELATIONSHIP: ___Coach___

First Last
COMPANY: ___Cass high school______________ TITLE: _Athletic coordinator__
E-MAIL: __________________________________ PHONE: _____________________
Page 2 of 3
FULL NAME: _______________________________ RELATIONSHIP: ______________
First Last
COMPANY: ________________________________ TITLE: ______________
E-MAIL: __________________________________ PHONE: _____________________
MILITARY SERVICE
ARE YOU A VETERAN? ☐ YES ☐ NO
BRANCH: _____________________ RANK AT DISCHARGE: _____________________
FROM: _____________________ TO: _____________________
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 ___Sebastian Sosa___________ DATE ___9/28/20____
PRINT NAME ______Sebastian Sosa__________
Page 3 of 3

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EMPLOYMENT / JOB APPLICATION

FULL NAME: _Sebastian__Antonio______Sosa____ DATE: ___9/28/20__

ADDRESS: _17 Juliana way________________________________________

E-MAIL: __Sebastiansosa300@yahoo.com_PHONE: ___678-899-5210__

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

DATE AVAILABLE: 9/28/20____ DESIRED PAY: $_________ ☐ HOUR ☐ SALARY

POSITION APPLIED FOR: General dentist_______________________

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: __Cass high school____ CITY / STATE: __White, GA__

FROM: _____2017_______ TO: ___2021____

GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________

COLLEGE: _______N/A__________ CITY / STATE: _____________________

FROM: _____________________ TO: _____________________

GRADUATE? ☐ YES ☐ NO DEGREE: _____________________

OTHER: _____________________ CITY / STATE: _____________________

OTHER: _____________________ CITY / STATE: _____________________

FROM: _____________________ TO: _____________________

EMPLOYER 1: ____La fiesta_________________________________________

E-MAIL: __________________________________ PHONE: ___ (770) 386-3563

ADDRESS: __ 62 Gilreath Rd SE Ste C ______________________________________

JOB TITLE: __warehouse packer___ RESPONSIBILITIES: __ packaging goods, placing

FROM: ____may 6_____ TO: _____july 26_____

REASON FOR LEAVING: _school _

FULL NAME: _Harry__________Wyche______ RELATIONSHIP: __Teacher___

COMPANY: _____BCCA___________ TITLE: _Teacher___

E-MAIL: __________________________________ PHONE: _____________________

FULL NAME: _Bobby___________Hughes____ RELATIONSHIP: ___Coach___

COMPANY: ___Cass high school______________ TITLE: _Athletic coordinator__

E-MAIL: __________________________________ PHONE: _____________________

COMPANY: ________________________________ TITLE: ______________

E-MAIL: __________________________________ PHONE: _____________________

ARE YOU A VETERAN? ☐ YES ☐ NO

BRANCH: _____________________ RANK AT DISCHARGE: _____________________

FROM: _____________________ TO: _____________________

TYPE OF DISCHARGE: _____________________

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 ___Sebastian Sosa___________ DATE ___9/28/20____

PRINT NAME ______Sebastian Sosa__________

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FULL NAME: _SebastianAntonio__Sosa DATE: _9/28/20__

E-MAIL: __Sebastiansosa300@yahoo.com_PHONE: _678-899-5210

SOCIAL SECURITY NUMBER (SSN): _--_

DATE AVAILABLE: 9/28/20 DESIRED PAY: $_____ ☐ HOUR ☐ SALARY

HIGH SCHOOL: Cass high school CITY / STATE: White, GA__

FROM: _2017_ TO: _2021____

COLLEGE: _N/A CITY / STATE: _________________

FROM: _ TO: _

OTHER: _ CITY / STATE: _

OTHER: _ CITY / STATE: _

FROM: _ TO: _

EMPLOYER 1: La fiesta_____________________________________

E-MAIL: ________________________________ PHONE: _ (770) 386-3563

ADDRESS: 62 Gilreath Rd SE Ste C ____________________________________

JOB TITLE: warehouse packer_ RESPONSIBILITIES: __ packaging goods, placing

FROM: __may 6_ TO: _july 26___

FULL NAME: _Harry____Wyche RELATIONSHIP: Teacher_

COMPANY: _BCCA_______ TITLE: _Teacher___

E-MAIL: ______________ PHONE: _

FULL NAME: _Bobby_________Hughes RELATIONSHIP: _Coach___

COMPANY: _Cass high school____________ TITLE: _Athletic coordinator__

E-MAIL: ______________ PHONE: _

COMPANY: __________________ TITLE:

E-MAIL: ______________ PHONE: _

BRANCH: _ RANK AT DISCHARGE: _

FROM: _ TO: _

SIGNATURE _Sebastian Sosa_______ DATE _9/28/20____

PRINT NAME Sebastian Sosa____