Employment application forms can vary substantially from
employer-to-employer. The following sample form will help familiarize you with
the format and types of information that you are likely to find on an
application form. Even if you have previously submitted a resume or other
information, many employers will require you to complete
an employment application form prior to being interviewed.
It is suggested that you print this sample form, fill it out, and take it with
you when you go for an interview. You can use the information on this form as a
reference when completing the employer's application form. You'll have almost
all the information you need at your fingertips.
Application for Employment
Contact Information
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Name:
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Last
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First
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Middle
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Address:
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Street
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City
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State
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Zip
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Telephone:
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( )
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( )
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Home
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Other
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Email:
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Emergency:
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( )
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Name
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Phone
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Position Applied For
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Job Title(s):
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(List all
that apply)
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Type of
Employment:
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[ ]
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[ ]
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[ ]
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Full-Time
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Part-Time
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Temporary
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Desired
Shift:
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[ ]
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[ ]
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[ ]
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Day
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Evening
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Night
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Available
Start Date:
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Desired
Salary:
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Work Experience
(list employers starting with the most recent)
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Employer:
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Address:
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Street
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City
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State
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Zip
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Telephone:
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( )
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( )
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Main Phone
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Fax
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Supervisor:
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( )
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Name &
Title
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Phone
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Employed
From:
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to
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(mm/dd/yy)
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(mm/dd/yy)
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Position
Held:
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Primary
Duties:
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Reason
for Leaving:
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Work Experience
(list employers starting with the most recent)
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Employer:
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Address:
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Street
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City
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State
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Zip
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Telephone:
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( )
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( )
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Main Phone
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Fax
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Supervisor:
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( )
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Name &
Title
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Phone
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Employed
From:
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to
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(mm/dd/yy)
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(mm/dd/yy)
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Position
Held:
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Primary
Duties:
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Reason
for Leaving:
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Work Experience
(list employers starting with the most recent)
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Employer:
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Address:
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Street
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City
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State
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Zip
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Telephone:
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( )
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( )
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Main Phone
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Fax
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Supervisor:
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( )
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Name &
Title
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Phone
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Employed
From:
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to
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(mm/dd/yy)
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(mm/dd/yy)
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Position
Held:
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Primary
Duties:
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Reason
for Leaving:
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Work Experience
(list employers starting with the most recent)
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Employer:
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Address:
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Street
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City
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State
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Zip
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Telephone:
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( )
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( )
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Main Phone
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Fax
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Supervisor:
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( )
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Name &
Title
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Phone
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Employed
From:
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to
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(mm/dd/yy)
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(mm/dd/yy)
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Position
Held:
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Primary
Duties:
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Reason
for Leaving:
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Work Experience
(list employers starting with the most recent)
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Employer:
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Address:
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Street
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City
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State
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Zip
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Telephone:
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( )
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( )
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Main Phone
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Fax
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Supervisor:
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( )
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Name &
Title
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Phone
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Employed
From:
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to
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(mm/dd/yy)
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(mm/dd/yy)
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Position
Held:
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Primary
Duties:
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Reason
for Leaving:
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Education
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Type of School
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Name of School
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Mailing Address
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Years Completed
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Diploma, Degree, and Major
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High School
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College
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Grad School
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Other
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Office Skills
(office staff only)
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Typing
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Yes [ ]
No [ ]
WPM: ______
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10-Key
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Yes [ ]
No [ ]
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Personal
Computer
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Yes [ ]
No [ ]
Model:
_____________
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Software
Applications (please list)
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Word Processing:
Spreadsheet:
Other:
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Military
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Have you
ever been in the armed forces?
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Yes [ ]
No [ ]
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Are you
a member of the National Guard?
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Yes [ ]
No [ ]
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Military
Specialty:
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Current
Status:
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Other Skills Or Experience
(not included above)
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Personal References
(do not include relatives or previous employers)
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Name:
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Last
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First
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Middle
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Address:
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Street
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City
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State
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Zip
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Telephone:
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( )
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( )
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Home
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Other
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Occupation:
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( )
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Company
Name & Job Title
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Phone
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Personal References
(do not include relatives or previous employers)
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Name:
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Last
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First
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Middle
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Address:
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Street
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City
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State
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Zip
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Telephone:
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( )
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( )
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Home
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Other
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Occupation:
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( )
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Company
Name & Job Title
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Phone
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May we contact
your current employer?
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Yes [ ]
No [ ]
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Agreement
I authorize the investigation
of all statements contained in this employment application form. I understand
that, if I am hired, any misrepresentation or omission of facts by me is
cause for immediate dismissal at any time. I hereby give the Company/Organization
permission to contact any or all schools, previous employers (unless otherwise
indicated), and references, and hereby release the Company/Organization
from any liability as a result of such contract.
I understand that the
Company/Organization has a pre-employment drug and alcohol testing policy.
Consent to and compliance with this policy is a pre-condition of my employment.
I further understand that employment may be based on the successful passing
of a job-related pre-employment physical examination.
I authorize the Company/Organization
to request from a consumer-reporting agency an investigative consumer report
including information about my credit records. Upon written request from
me, the Company/Organization will provide me with information concerning
the nature and scope of any such report, as required by the Fair Credit
Reporting Act.
I further understand
that my employment with the Company/Organization is "at will," meaning it
can be terminated at will for any reason and at any time by myself or by
the Company/Organization.
Signature of applicant:___________________________________
Date:________________
This Company/Organization
is an equal employment opportunity employer.
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