HNASIUM The Math Learning Center on Employment Application 712 E Roosevelt Rd (630)469-6284 Fax (630)469-6544 glenellyn@mathnasium.com www.mathnasium.com Applicant Information Full Name: RAZ yz Musa g Date: _O1 /17 20 Ga Fist it Address: __32¢ AMA ‘Sireet Adress ‘Apartment e EW DALE _b TL gical ci “Sate IP Code Phone: _(¢ 30) 432~9/73 ______ E-mail Address: BARAZVE @ GMATL. com Social Securiy Desired Date Avaliable: 0) / 17 No. R25 -9n-3537 Salary: $ — _perhr Position Applied for: _AgaTH. TutoR YES NO NO ‘Are you a citizen of the United States? @Z_ Ot no, are you authorized to work in the U.S.? Q YES NO Have you ever worked for this company? C]._- )_itf so, when? Have you ever been convicted of a YES NO felony? oOo Ityes, explain: righ Schook GLEWRARD WEST Address:G10 CRESCENTAW GLEN ELLYN | TL go137 Yes WO YES NO Did you graduate? 2} O If no, did you eam a GED? Qo Qa College: BENEDTCTENE UNIVERSLTYAddeSs: S100 COLLEGE RD. Yes NO From: To: PRESENT Didyougraduate? C} Degree: Other: Address: ve 10 From: To Did you graduate? §—O_egree: Please list three professional references. FullName: _ARuA AMIE Relationship: _Coworke Company: UAL 4.2 RT Phone: (630) 202 - o345 Address: ee FullName: ean Mires Relationship PS > Company: uweTep HVAC Phone: (#47 ) Address FullName: ELEN 211 TAK _ Reletionshi’ CALCULUS PRatés son Company: BENEDICTINE uirversETy Phone: (39) 24- «s - Address:Seen Company: COpece oF puPaec Phone: (430) 442-2330 Address: 2s FAWELL BLVD ya LL ois Superisor, JEFF RER JobTile: COMeuTER LAB AZ Staring Salary: $_g Ending Salary: _$ 2 50 Responsibilies: APDRESESG TECHNOLOGY TSSUES FoR sTupeWTs AND FAcuITy From: {2/200q To: o62010 _ Reason for Leaving PLUNTARY QuxT Yes "NO a oye May we contact your previous supervsorforareference? § C]._ J (HE Was LEFT THE comraniy) Company: _USAL- AA! Phone: (649) £93- $000 Address: 3/4 9 ARMY TRATL ROA Supenisor KyLG sumMmens Job Tile: GARDEN sALes AssocrATE Stating Salay: $ 2.12 Ending Salary: $2 12 Responsibilities: _Cusramen seavice From: 97/2007 To: wj/200q _ ReasontorLeaving: _ VoLlunraty Qua NS May we contact your previous supervisor fo a reference? a Company: UTED VAC Phone: (27) upg = 4746 Address: _WW/A _ Supeniso: TE Mean Mreza. sob Tite Starting Salary: $ 4.09 Ending Salary: _$ 4.00 Responsibilies: ome r/PRove TLAMDSCAPENG From: 9g/2001 To: _07/2007 Reasonfor Leaving: __ TEMPORARY (s¢AssvAL) EMPLOY HEWT sO May we contact your previous supervisor forareference? = sO) Erne Full ER RAZUE _ Relationship: / Name: _ QA Bec eees Monday Tuesday Ply. 2 Pa Wednesday Real Phone 2) Y74-9yoePhone2: (430) 422-4173 Thursday LLM. Saturday _— Sunday LA Erne | certify that my answers are true and complete to the best of my knowledge. By signing this application | authorize ‘Mathnasium or its designated representative to conduct a criminal background investigation, If this application leads to employment, | understand that false or misleading information in my application or interview ‘may result in disqualification or release from employment. Signatwe: 2flaache'f -