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Employment Work History Form
Lamar State College-Orange Dental Assiting Program

Employment Work History Form

Start with your present or last job. Include military service assignments and volunteer activities. You may exclude organization names which indicate race, color, religion, gender, national origin, handicap, or other protected status.


1.
Employer __________________________________________________
Telephone ( __________ ) __________ - ____________________
Street __________________________________________________
City __________________________________________________
State __________
Zip __________
Job Title __________________________________________________
Supervisor's Name __________________________________________________
Started Job ____________________
(If Applicable) Ended Job ____________________
Reason for leaving __________________________________________________
__________________________________________________

2.
Employer __________________________________________________
Telephone ( __________ ) __________ - ____________________
Street __________________________________________________
City __________________________________________________
State __________
Zip __________
Job Title __________________________________________________
Supervisor's Name __________________________________________________
Started Job ____________________
(If Applicable) Ended Job ____________________
Reason for leaving __________________________________________________
__________________________________________________

3.
Employer __________________________________________________
Telephone ( __________ ) __________ - ____________________
Street __________________________________________________
City __________________________________________________
State __________
Zip __________
Job Title __________________________________________________
Supervisor's Name __________________________________________________
Started Job ____________________
(If Applicable) Ended Job ____________________
Reason for leaving __________________________________________________
__________________________________________________

4.
Employer __________________________________________________
Telephone ( __________ ) __________ - ____________________
Street __________________________________________________
City __________________________________________________
State __________
Zip __________
Job Title __________________________________________________
Supervisor's Name __________________________________________________
Started Job ____________________
(If Applicable) Ended Job ____________________
Reason for leaving __________________________________________________
__________________________________________________

5.
Employer __________________________________________________
Telephone ( __________ ) __________ - ____________________
Street __________________________________________________
City __________________________________________________
State __________
Zip __________
Job Title __________________________________________________
Supervisor's Name __________________________________________________
Started Job ____________________
(If Applicable) Ended Job ____________________
Reason for leaving __________________________________________________
__________________________________________________

6.
Employer __________________________________________________
Telephone ( __________ ) __________ - ____________________
Street __________________________________________________
City __________________________________________________
State __________
Zip __________
Job Title __________________________________________________
Supervisor's Name __________________________________________________
Started Job ____________________
(If Applicable) Ended Job ____________________
Reason for leaving __________________________________________________
__________________________________________________