1. Peoria Unified School District #11
Work Based Learning
CTE/Professional Internship
Employment Application
DIRECTIONS: Read carefully and fill in ALL items. Incomplete or unsigned applications
will not be accepted.
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Last Name First Name Middle Initial
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Address City State Zip Code
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Home Phone Cell Phone E-mail
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Birth Date Date Available Starting Time
Work History
Begin with your current or most recent position. List each promotion as a separate job. Include paid and voluntary
positions. Be as accurate and complete as possible, especially in describing the duties of each position.
Current or Most Recent Position:
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Name of Employer/Company Job Title Dates of Employment (From - To)
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Employer’s Address City State Zip Code
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Name of Supervisor Hours Per Week Reason for Leaving
Description of Duties:
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Next Previous Position:
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Name of Employer/Company Job Title Dates of Employment (From - To)
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Employer’s Address City State Zip Code
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Name of Supervisor Hours Per Week Reason for Leaving
Description of Duties:
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Castellanos Nicholas M
601 S 115th Dr. Avondale Az 85323
(760)-987-9844 (602)-577-6375 nicocastell@icloud.com
February 1, 1999 ASAP 6 pm
Sprouts Farmers Market Bagger 07/07/2015-current
1813 N Dysart Rd Avondale Az 85392
Steve Pennington 5-20 N/A
Bag, clean, take out trash, stock items, customer service, make ice,
N/A

2. Education and Training
College:
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Name of College Dates Attended - Month/Year
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Address City State Zip Code
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Classes
High School:
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Name of High School Dates Attended - Month/Year
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Address City State Zip Code
Use this space to identify any career and technical education classes you have received a “C” or better
(i.e., Welding, Ag, Media, Culinary, Business Foundations, Life FACS, Drafting, Child Development, etc).
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List any relevant certificates and licenses (Food Handlers, CPR, etc.), or specialized classes you have taken
(i.e., Chemistry, Anatomy, Journalism, Photography, etc.)
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Please give any additional information you feel is pertinent that is not listed elsewhere. Do not leave it blank
.
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List Three References
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Reference #1: List name Address City State Zip Code Phone Number
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Reference #2: List name Address City State Zip Code Phone Number
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Reference #3: List name Address City State Zip Code Phone Number
Signature: By signing this application, you are certifying that the information is true and complete to the best of your
knowledge. Unsigned applications will not be considered.
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Signature Date
N/A
Centennial High School 08/2013
14388 N 79th Ave Peoria Az 85381
Culinary, Ceramics, Human Physiology
I am an fervent and intelligent character who always thinks positively.
Abby Gray 14388 N 79th Ave Peoria AZ 85381 (623)-363-2310
Steve Ybarra 14388 N 79th Ave Peoria AZ 85381 (623)-570-9714
Susan Leon 14388 N 79th Ave Peoria AZ 85381 (520)-465-6812