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Peoria Unified School District #11
Work Based Learning
CTE/Professional Internship
Employment Application
DIRECTIONS: Read carefully and fill in ALL items. Incomplete or unsigned applications
will not be accepted.
__________________________________________________________________________________________________________________________
Last Name First Name Middle Initial
__________________________________________________________________________________________________________________________
Address City State Zip Code
__________________________________________________________________________________________________________________________
Home Phone Cell Phone E-mail
__________________________________________________________________________________________________________________________
Birth Date Date Available Starting Time
Work History
Begin with your current or most recent position. List each promotion as a separate job. Include paid and voluntary
positions. Be as accurate and complete as possible, especially in describing the duties of each position.
Current or Most Recent Position:
__________________________________________________________________________________________________________________________
Name of Employer/Company Job Title Dates of Employment (From - To)
__________________________________________________________________________________________________________________________
Employers Address City State Zip Code
__________________________________________________________________________________________________________________________
Name of Supervisor Hours Per Week Reason for Leaving
Description of Duties:
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Next Previous Position:
__________________________________________________________________________________________________________________________
Name of Employer/Company Job Title Dates of Employment (From - To)
__________________________________________________________________________________________________________________________
Employers Address City State Zip Code
__________________________________________________________________________________________________________________________
Name of Supervisor Hours Per Week Reason for Leaving
Description of Duties:
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Castellanos Nicholas M
601 S 115th Dr. Avondale Az 85323
(760)-987-9844 (602)-577-6375 nicocastell@icloud.com
February 1, 1999 ASAP 6 pm
Sprouts Farmers Market Bagger 07/07/2015-current
1813 N Dysart Rd Avondale Az 85392
Steve Pennington 5-20 N/A
Bag, clean, take out trash, stock items, customer service, make ice,
N/A
Education and Training
College:
__________________________________________________________________________________________________________________________
Name of College Dates Attended - Month/Year
__________________________________________________________________________________________________________________________
Address City State Zip Code
__________________________________________________________________________________________________________________________
Classes
High School:
__________________________________________________________________________________________________________________________
Name of High School Dates Attended - Month/Year
__________________________________________________________________________________________________________________________
Address City State Zip Code
Use this space to identify any career and technical education classes you have received a C or better
(i.e., Welding, Ag, Media, Culinary, Business Foundations, Life FACS, Drafting, Child Development, etc).
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
List any relevant certificates and licenses (Food Handlers, CPR, etc.), or specialized classes you have taken
(i.e., Chemistry, Anatomy, Journalism, Photography, etc.)
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Please give any additional information you feel is pertinent that is not listed elsewhere. Do not leave it blank
.
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
List Three References
__________________________________________________________________________________________________________________________
Reference #1: List name Address City State Zip Code Phone Number
__________________________________________________________________________________________________________________________
Reference #2: List name Address City State Zip Code Phone Number
__________________________________________________________________________________________________________________________
Reference #3: List name Address City State Zip Code Phone Number
Signature: By signing this application, you are certifying that the information is true and complete to the best of your
knowledge. Unsigned applications will not be considered.
__________________________________________________________________________________________________________________________
Signature Date
N/A
Centennial High School 08/2013
14388 N 79th Ave Peoria Az 85381
Culinary, Ceramics, Human Physiology
I am an fervent and intelligent character who always thinks positively.
Abby Gray 14388 N 79th Ave Peoria AZ 85381 (623)-363-2310
Steve Ybarra 14388 N 79th Ave Peoria AZ 85381 (623)-570-9714
Susan Leon 14388 N 79th Ave Peoria AZ 85381 (520)-465-6812
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EmploymentApplicationFillable

  • 1. Peoria Unified School District #11 Work Based Learning CTE/Professional Internship Employment Application DIRECTIONS: Read carefully and fill in ALL items. Incomplete or unsigned applications will not be accepted. __________________________________________________________________________________________________________________________ Last Name First Name Middle Initial __________________________________________________________________________________________________________________________ Address City State Zip Code __________________________________________________________________________________________________________________________ Home Phone Cell Phone E-mail __________________________________________________________________________________________________________________________ Birth Date Date Available Starting Time Work History Begin with your current or most recent position. List each promotion as a separate job. Include paid and voluntary positions. Be as accurate and complete as possible, especially in describing the duties of each position. Current or Most Recent Position: __________________________________________________________________________________________________________________________ Name of Employer/Company Job Title Dates of Employment (From - To) __________________________________________________________________________________________________________________________ Employers Address City State Zip Code __________________________________________________________________________________________________________________________ Name of Supervisor Hours Per Week Reason for Leaving Description of Duties: __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ Next Previous Position: __________________________________________________________________________________________________________________________ Name of Employer/Company Job Title Dates of Employment (From - To) __________________________________________________________________________________________________________________________ Employers Address City State Zip Code __________________________________________________________________________________________________________________________ Name of Supervisor Hours Per Week Reason for Leaving Description of Duties: __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ Castellanos Nicholas M 601 S 115th Dr. Avondale Az 85323 (760)-987-9844 (602)-577-6375 nicocastell@icloud.com February 1, 1999 ASAP 6 pm Sprouts Farmers Market Bagger 07/07/2015-current 1813 N Dysart Rd Avondale Az 85392 Steve Pennington 5-20 N/A Bag, clean, take out trash, stock items, customer service, make ice, N/A
  • 2. Education and Training College: __________________________________________________________________________________________________________________________ Name of College Dates Attended - Month/Year __________________________________________________________________________________________________________________________ Address City State Zip Code __________________________________________________________________________________________________________________________ Classes High School: __________________________________________________________________________________________________________________________ Name of High School Dates Attended - Month/Year __________________________________________________________________________________________________________________________ Address City State Zip Code Use this space to identify any career and technical education classes you have received a C or better (i.e., Welding, Ag, Media, Culinary, Business Foundations, Life FACS, Drafting, Child Development, etc). __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ List any relevant certificates and licenses (Food Handlers, CPR, etc.), or specialized classes you have taken (i.e., Chemistry, Anatomy, Journalism, Photography, etc.) __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ Please give any additional information you feel is pertinent that is not listed elsewhere. Do not leave it blank . __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ List Three References __________________________________________________________________________________________________________________________ Reference #1: List name Address City State Zip Code Phone Number __________________________________________________________________________________________________________________________ Reference #2: List name Address City State Zip Code Phone Number __________________________________________________________________________________________________________________________ Reference #3: List name Address City State Zip Code Phone Number Signature: By signing this application, you are certifying that the information is true and complete to the best of your knowledge. Unsigned applications will not be considered. __________________________________________________________________________________________________________________________ Signature Date N/A Centennial High School 08/2013 14388 N 79th Ave Peoria Az 85381 Culinary, Ceramics, Human Physiology I am an fervent and intelligent character who always thinks positively. Abby Gray 14388 N 79th Ave Peoria AZ 85381 (623)-363-2310 Steve Ybarra 14388 N 79th Ave Peoria AZ 85381 (623)-570-9714 Susan Leon 14388 N 79th Ave Peoria AZ 85381 (520)-465-6812