Nov-09-06 08:09P Reimer Employment 561 655 4109 P.01 MO DAY YP. APPLICATION FOR EMPLOYMENT NAmg• \t v-e 7 . 2cA v 1 u.nat--, ADDRESS: (Street) (City) (State) (Zip Code) IN CASE OF AN-EMERGENCY CONTACT (Pe irtie POSITION DESIRED: LIVE: IN C-<21UT SOCIAL SECURITY # 6,51roo SALARY DESIRLD:ai 4CV DATE OF BIRTH: 2 4;03 U LEAST ACCEPTABLE. tat-t~"MARRIED• SINGLE: WILLING TO RELOCATE _L---......-WHF-RE:E29),-.Coadjr N OF CHILDREN AGES B G_ LANGUAGES SPOKEN: is:34;a, DRIVERS LICENSE: Yes L'1‘ COUNTRY OF BIRTH- -Bin OWN CAR? Vri,-c GREENCARI)- Yes. _No ACCEPT POSITION WITH CHILDREN: Yes `----No USA CITIZEN: Yes 1---41-o DO YOU COOK : Yes DO YOU SM 3KE: Yes No If yes-what type? Gourmet—Good Family Cooking Plain DO YOU HA •/E ANY ALLERGIES- Yes__NoS. If "Yes" what are you allergic to? Ilow were yoL referred to us' Newspaper ✓ Yellow Pages Friend . Other PRESTOUS EMPLOYMENT 11151ORY DATES Fmm 0 EMPLOYER AND ADDRESS Office use only TELEPHONE POSITION From rer (OM 0: From: o SALARY Reason Left Ref sent le()R OFFICE ONE ONLY - DO NOT WRITE BELOW ATE REFERRED TO COMMENTS CONFIDENTIAL MM13-EMPLOYEES-JE-000121 3501.183-010 Page I of 1 EFTA_00072519 EFTA01248164