A	B	C	D	E	F	G
1	Portland Housing Bureau
2
4	Applicant Name:			Position:		Date:
6	Please list the following information for the past three paid positions you have held:
8	Employer Name	Location (City/State)	Job Title	Ending Salary	Reason for Leaving	Supervisor Phone #	OK to contact employer for reference? (Y/N)
12	Please provide professional references:
14	Name	Title/Employer	Organization/ Company Name	Phone Number	Personal or Professional