EMPLOYMENT APPLICATION Bead Inspirations 1544 Park St. Alameda, CA 94501 510-337-1203 www.beadinspirations.com create@beadinspirations.com

INSTRUCTIONS: Complete the application form in ink or typed. Bead Inspirations is an Equal Opportunity-Affirmative
Action Employer providing equal employment opportunity to all regardless of sex, race, color, religion, ancestry, national
origin, age, marital status, medical condition (cancer related), or physical handicap.

1. Title of Position:

2. Your Social Security Number: - - (For Identification Purposes Only)

3. Your Name: Last First Middle

4. Address: Number and Street City State Zip

Mailing Address

Physical Address

Email Address

5. Telephone Number: Home: ( ) - Cell: ( ) - Business: ( ) - Ext:

6. Can you, after employment, submit verification of your legal right to work in the United States? Yes No

7. As an adult, have you ever been convicted of a misdemeanor or felony offense other than a minor traffic violation?

Yes No

If "YES", please give date and nature of the offense below. (Convictions are evaluated for each position and are not necessarily disqualifying):

8. Do you have a valid California driver's license? Yes Class Number No

  9. Indicate the type of position you will accept: Full-time permanent (40 hours per week)

Part-time permanent position (fewer than 40 hours per week) Extra Help position (hours per week may vary)

10. Do you speak any languages other than English?            Yes No If yes, please list:

11. Skills: Please list relevant skills and abilities.

_______________________________	_______________________________	_______________________________
_______________________________	_______________________________	_______________________________
_______________________________	_______________________________	_______________________________

12. EDUCATION: Did you graduate from high school? Yes No If "NO" did you receive a GED? Yes No

If "NO", indicate highest year completed: 1 2 3 4 5 6 7 8 9 10 11 12

Name and Location of High School:
Name and Location of College or University	Major		Semester Units Completed	Quarter Units Completed	Degree Conferred
					Type: Date:
					Type: Date:
					Type: Date:
Business, Correspondence, Trade or Service Schools		Course of Study

13. EXPERIENCE: Beginning with most recent job, please fully account for all time, including periods of unemployment,
military service, and relevant volunteer experience. If you were employed under another name, write in the name by which you
were known to your employer. If additional space is needed, attach a sheet of paper. By listings names of prior employers and
supervisors, you are consenting, unless otherwise indicated in writing, to Bead Inspirations contacting those persons
specifically listed (or persons who are available through the employer if the supervisor listed is no longer employed) for
purposes of confirming information relating to your prior employment including but not limited to, providing a reference.

Dates of Employment and Salary Received	Job Title(s) and Duties Performed	Employer's Name, Address, Phone and Type of Business
From Month Year To Month Year Salary:	Job Title: Hours Per Week: Supervisor's Name: Job Duties: Number of Persons Supervised:	Reason for Leaving:
From Month Year To Month Year Salary:	Job Title: Hours Per Week: Supervisor's Name: Job Duties: Number of Persons Supervised:	Reason for Leaving:
From Month Year To Month Year Salary:	Job Title: Hours Per Week: Supervisor's Name: Job Duties: Number of Persons Supervised:	Reason for Leaving:
From Month Year To Month Year Salary:	Job Title: Hours Per Week: Supervisor's Name: Job Duties: Number of Persons Supervised:	Reason for Leaving:

14. May we contact your present employer? Yes No

15. List memberships in professional organizations that you feel would enhance your application. You may exclude, if you wish,
any whose names would indicate the race, religion, age, color, national origin, marital status, gender, sexual orientation or
ancestry of its members.
________________________________________________________________________________________________
________________________________________________________________________________________________

16. Professional licenses or certifications:_________________________________________________________________

17. List memberships in professional organizations that you feel would enhance your application. You may exclude, if you wish,
any whose names would indicate the race, religion, age, color, national origin, marital status, gender, sexual orientation or
ancestry of its members.
________________________________________________________________________________________________
________________________________________________________________________________________________

18. References: Give names and addresses of two people, not relatives, who have knowledge of your skills, experience, and ability.

Name

Address

Telephone Number

19. Person who we may notify in case of emergency:

Name

Address

Telephone Number