Application for Employment

Southeast Uplift Neighborhood Program, Inc.

3534 SE Main Street   Portland OR 97214 503-232-0010 (fax) 503-232-5265

Lents Town Center Urban Renewal Area

“Lents Business Canvass”

Name

Address

Daytime Phone        Evening Phone

Social Security Number

Previous Employers

Company    Position    Address    Dates employed

1.

2.

3.

References

Name        Relationship      Phone Number

1.

2.

3.

Are you available during the day from 9am-6pm?

Mon 3/26____  Tues 3/27____  Wed 3/28____  Thurs 3/29___   Fri 3/30_____  

Mon 4/2_____ Tues 4/3_____ Wed 4/4____ Thurs 4/5____ Fri 4/6_______

Do you have reliable transportation to ensure that you are punctual? ____________