Application For Employment
(prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status)
Personal
Date
Last Name
First Name
Middle Name
Street Address
City, State, Zip
Home Telephone Number
Business Telephone Number
Social Security Number
Pay Expected?
Position Desired?
Will you work overtime if asked?
Yes
No
Apart from absence for religious observance, are you available for full-time work?
Yes
No
If not, what hours can you work?
Have you ever applied for employment with us?
Yes
No
If Yes, Month & Year?
Location?
Are you legally eligible for employment in the United States?
When will you be available to begin work?
Other special training or skills (languages, machine operation, etc.)
Education
Graduate School
Name & Location of School
Course of Study
Number of Years Completed
Did You Graduate?
Yes
No
Degree or Diploma
College
Name & Location of School
Course of Study
Number of Years Completed
Did You Graduate?
Yes
No
Degree or Diploma
Business/Trade/Technical
Name & Location of School
Course of Study
Number of Years Completed
Did You Graduate?
Yes
No
Degree or Diploma
High School
Name & Location of School
Course of Study
Number of Years Completed
Did You Graduate?
Yes
No
Degree or Diploma
Membership in Professional or Civic Organizations (exclude those which may disclose your race, color, religion or national origin)
Employment
(please give accurate, complete full-time & part time employment record. Start with your present or most recent employer)
Employment 1
Company Name
Telephone Number
Address
Employed (state month & year)
From
To
Name of Supervisor
Weekly Pay
Start
Last
State Job Title & Describe Your Work
Reason for Leaving?
Employment 2
Company Name
Telephone Number
Address
Employed (state month & year)
From
To
Name of Supervisor
Weekly Pay
Start
Last
State Job Title & Describe Your Work
Reason for Leaving?
Employment 3
Company Name
Telephone Number
Address
Employed (state month & year)
From
To
Name of Supervisor
Weekly Pay
Start
Last
State Job Title & Describe Your Work
Reason for Leaving?
Employment 4
Company Name
Telephone Number
Address
Employed (state month & year)
From
To
Name of Supervisor
Weekly Pay
Start
Last
State Job Title & Describe Your Work
Reason for Leaving?
We may contact the employers listed above unless you indicate those you do not want us to contact
Do not contact employer number(s)
Reason
Military
Did you serve in the U.S. Armed Forces?
Yes
No
If "Yes," what branch?
Describe any training received relevant to the position for which you are applying
The following requested information is needed for a legally permissible reason ...
Including, without limitation, national security considerations, a legitimate occupational qualification or business necessity. The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also prohibits discrimination based on age, citizenship and disability. The laws of most states also prohibit some or all of the above types of discrimination as well as some additional types such as discrimination based upon ancestry, marital status and sexual preference.
Provide Dates You Attended School
High School
From
To
College
From
To
Other (give name & dates)
Marital Status
Single
Separated
Engaged
Divorced
Married
Widowed
What was your previous address?
Have you ever been bonded?
Yes
No
If "Yes," with what employers?
Have you ever been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court?
Yes
No
If "Yes," describe in full
State names of relatives and friends working for us, other than your spouse.
The information provided in this Application for Employment is true, correct and complete. If you employ me, any misstatement or omission of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment creates no obligation upon you, the employer, to continue to employ me in the future.
Date
*
Name
*
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