UNITED STATES GOVERNMENT

Senator

APPLICANT INFORMATION
Dat
Last Name Doe First Jane M.I. M 5-10-2017
e
Street Apartment/Unit
695 Court Dr.
Address #
City Hickory State North Carolina ZIP 28602
E-mail
Phone (980)-624-3345 janedoe@gmail.com
Address
Date Social Security Desired
5-10-2017 259-78-9956 $175,000/year
Available No. Salary
Position Applied
Senator
for
Are you a citizen of the United If no, are you authorized to work in the
YES NO YES NO
States? U.S.?
Have you ever worked for this
YES NO If so, when?
company?
Have you ever been convicted of a If yes,
YES NO
felony? explain

EDUCATION
High Addres
South Pointe High School 1330 Main St., Charlotte, NC 28630
School s
Did you
From 1990 To 1994 YES NO Degree High School Diploma
graduate?
Colleg Addres
University of North Carolina 1000 Ridge Rd., Chapel Hill, NC, 27514
e s
Did you
From 1994 To 2000 YES NO Degree Masters Degree in Political Science
graduate?
Addres
Other
s
Did you
From To YES NO Degree
graduate?

REFERENCES
Please list three references.
Relationshi
Full Name John Doe Husband
p
Company Apple Phone (980)-914-4765

Address 695 Court Dr., Hickory NC, 28602

Relationshi
Full Name Mary Margolis Employer
p
Company Margolis & Matthews Law Firm Phone (980)-975-8654

Address 1310 N Main St., Hickory NC, 28602

Relationshi
Full Name Thomas Knight Employer
p
Company North Carolina Attorney General Phone (888)-556-2235

Address 555 Central Ave., Statesville NC, 28520

PREVIOUS EMPLOYMENT
Company Margolis & Matthews Law Firm Phone (980)-975-8654
Superviso
Address 1310 N Main St., Hickory NC, 28602 Mary Margolis
r
Starting Ending
Job Title Attorney $ 100,000 $ 150,000
Salary Salary
Responsibilities Civil law suits

From 2005 To 2016 Reason for Leaving Relocated

May we contact your previous supervisor for a
YES NO
reference?
Company North Carolina Attorney General Phone (888)-556-2235
Superviso
Address 555 Central Ave., Statesville NC, 28520 Thomas Knight
r
Starting Ending
Job Title Lobbyist $60,000 $ 80,000
Salary Salary
Responsibilities Answer phone calls and make appointments

From 2000 To 2005 Reason for Leaving New opportunities

May we contact your previous supervisor for a
YES NO
reference?
Company n/a Phone n/a
Superviso
Address n/a n/a
r
Starting Ending
Job Title n/a $ n/a $ n/a
Salary Salary
Responsibilities n/a

From n/a To n/a Reason for Leaving n/a

May we contact your previous supervisor for a
YES NO n/a
reference?

MILITARY SERVICE
Branch n/a From n/a To n/a

Rank at Discharge n/a Type of Discharge n/a

If other than honorable,
n/a
explain

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.

Signature Jane Marie Doe Date 5-10-2017