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Sample Employment Application

  

This Company  is an equal opportunity/affirmative action employer.  All qualified applicants will be considered without regard to age, race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

 


 

Personal

 

 

 

 

 

Last Name                                        First                                           Initial

 

Social Security #

 

 

Other Name(s) Used

 

Home Telephone #

(       )

 

Address

 

Business or Message #

(       )

 

Position Applied For

 

Referred By

 

Salary Desired

 

 

Have you ever interviewed with the Company or its affiliates before?  ¨ Yes¨ No

 

If yes, list date(s), job title(s) & location(s)

 

Have you ever been employed by the Company or its affiliates before?  ¨ Yes¨ No

 

If yes, list date(s), job title(s) & location(s)

 

Do you have any relatives employed by the Company or its affiliates?             ¨ Yes¨ No

 

If yes, list date(s), job title(s) & location(s)

 

Are you at least 18 years old?

¨ Yes¨ No

 

If under 18, do you have a work permit?

 

 

 

Education

 

 

 

 

 

 

 

Circle Highest Grade Completed:           High School                             9        10         11         12

College, Trade or Business        1          2          3          4

Graduate Studies                                                          

 

School

 

Address

 

Major Studies

 

Degree, Diploma,

License or Certificate

 

High School

 

 

 

 

 

 

 

 

College/University

 

 

 

 

 

 

 

 

Vocational, Business, Other

 

 

 

 

 

 

 

 

List Any Professional Designations

 

 

Other Special Knowledge, Skills or Qualifications

 

 

 

For Clerical Applicants Only:

 

Do you type? ¨ Yes             ¨ No                         If yes, WPM:

 

 

Computer Skills (Hardware/Software)

 

 

Employment History

 

List all employments for the past 10 years, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.

 

 

Employed From

/          /

 

Employer Name

 

Supervisor Name

 

Starting Salary

 

Employed Until

/          /

 

Employer Address

 

Supervisor Phone #

 

Ending Salary

 

Job Title

 

 

Reason for Leaving

 

Duties & Responsibilities

 

 

 

 

 

 

Employed From

/          /

 

Employer Name

 

Supervisor Name

 

Starting Salary

 

Employed Until

/          /

 

Employer Address

 

Supervisor Phone #

 

Ending Salary

 

Job Title

 

 

Reason for Leaving

 

Duties & Responsibilities

 

 

 

 

 

 

Employed From

/          /

 

Employer Name

 

Supervisor Name

 

Starting Salary

 

Employed Until

/          /

 

Employer Address

 

Supervisor Phone #

 

Ending Salary

 

Job Title

 

 

Reason for Leaving

 

Duties & Responsibilities

 

 

 

 

 

 

Employed From

/          /

 

Employer Name

 

Supervisor Name

 

Starting Salary

 

Employed Until

/          /

 

Employer Address

 

Supervisor Phone #

 

Ending Salary

 

Job Title

 

 

Reason for Leaving

 

Duties & Responsibilities

 

 

 

 

 

General

 

Yes     No

 

¨       ¨            May we contact your current employer for references?

 

¨       ¨            If hired, will you be able to work overtime?

 

¨       ¨            Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodation?

 

¨       ¨            Have you ever been convicted of any crime, (excluding convictions for marijuana related offenses for personal use more then two years old, convictions that have been sealed, expunged or legally eradicated, or misdemeanors for which probation was completed and the case was dismissed by court?  (Note: A Yes response does not automatically disqualify your application.) If Yes, please explain.

 

¨                 ¨   Are you currently out on bail or released on your own recognizance pending  

         Trial? If  Yes, explain.

 

  

 

 

Certification & Authorization

 

The above information is true and correct. I understand that the hiring process will be terminated, or in the event of my employment by the Company, I shall be subject to dismissal, if any information that I have given in this application, the background relese form, in any resume or interview or any part of the hiring process is false or misleading or if I have failed to give any information herein requested, or if I have withheld relevant information, regardless of the time elapsed after discovery.

 

I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information.  I further authorize the Company to obtain any credit and consumer check.

 

I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary I understand and agree that, if hired, my employment will be terminable at will and may be terminated by me or the Company at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.

 

If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.

 

I hereby acknowledge that I have read and agree to the above statements.

 

 

                                                                                                                                                            

Signature                                                                                   Date