Employment Application Form


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

Name:

Last

First

Middle

Address:

Street

City

State

Zip

Telephone:

( )

( )

Home

Other

Email:

Emergency:

( )

Name

Phone

Position Applied For

Job Title(s):

(List all that apply)

Type of Employment:

[ ]

[ ]

[ ]

Full-Time

Part-Time

Temporary

Desired Shift:

[ ]

[ ]

[ ]

Day

Evening

Night

Available Start Date:

Desired Salary:


Work Experience (list employers starting with the most recent)

Employer:

Address:

Street

City

State

Zip

Telephone:

( )

( )

Main Phone

Fax

Supervisor:

( )

Name & Title

Phone

Employed From:

to

(mm/dd/yy)

(mm/dd/yy)

Position Held:

Primary Duties:

Reason for Leaving:


Work Experience (list employers starting with the most recent)

Employer:

Address:

Street

City

State

Zip

Telephone:

( )

( )

Main Phone

Fax

Supervisor:

( )

Name & Title

Phone

Employed From:

to

(mm/dd/yy)

(mm/dd/yy)

Position Held:

Primary Duties:

Reason for Leaving:


Work Experience (list employers starting with the most recent)

Employer:

Address:

Street

City

State

Zip

Telephone:

( )

( )

Main Phone

Fax

Supervisor:

( )

Name & Title

Phone

Employed From:

to

(mm/dd/yy)

(mm/dd/yy)

Position Held:

Primary Duties:

Reason for Leaving:


Work Experience (list employers starting with the most recent)

Employer:

Address:

Street

City

State

Zip

Telephone:

( )

( )

Main Phone

Fax

Supervisor:

( )

Name & Title

Phone

Employed From:

to

(mm/dd/yy)

(mm/dd/yy)

Position Held:

Primary Duties:

Reason for Leaving:


Work Experience (list employers starting with the most recent)

Employer:

Address:

Street

City

State

Zip

Telephone:

( )

( )

Main Phone

Fax

Supervisor:

( )

Name & Title

Phone

Employed From:

to

(mm/dd/yy)

(mm/dd/yy)

Position Held:

Primary Duties:

Reason for Leaving:


Education

Type of School

Name of School

Mailing Address

Years Completed

Diploma, Degree, and Major

High School

College

Grad School

Other

Office Skills (office staff only)

Typing

Yes [ ]

No [ ]

WPM: ______

10-Key

Yes [ ]

No [ ]

Personal Computer

Yes [ ]

No [ ]

Model: _____________

Software Applications (please list)

Word Processing:

Spreadsheet:

Other:

Military

Have you ever been in the armed forces?

Yes [ ]

No [ ]

Are you a member of the National Guard?

Yes [ ]

No [ ]

Military Specialty:

Current Status:

Other Skills Or Experience (not included above)


Personal References (do not include relatives or previous employers)

Name:

Last

First

Middle

Address:

Street

City

State

Zip

Telephone:

( )

( )

Home

Other

Occupation:

( )

Company Name & Job Title

Phone

Personal References (do not include relatives or previous employers)

Name:

Last

First

Middle

Address:

Street

City

State

Zip

Telephone:

( )

( )

Home

Other

Occupation:

( )

Company Name & Job Title

Phone


May we contact your current employer?

Yes [ ]

No [ ]



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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