Employment Application

Date                _______________________

Name              _______________________________________________

Address         _______________________________________________

City                 _________________________ Zip____________________

Birthdate       _________________________ Age___________________

Phone            (________)_______________________________________

E-mail            ________________________________________________

Social Security Number  ____________ - ____________ - ___________

Reference      _______________________________________________

            Phone              (________) ________________________________

Type of work sought: ________________________________________

___________________________________________________________

___________________________________________________________

Additional Information: _______________________________________

___________________________________________________________

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1250 - 5th Street • Ferndale, CA 95536
email: humcofair@frontiernet.net • www.humboldtcountyfair.org
___________________________________________________________
707.786.9511 (Phone) • 707.786.9450 (Fax)