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Exercise Extreme Caution when using many of our free forms - or any legal material. While they may provide general ideas on format & content, validity requirements can and do vary greatly from state to state. Many MUST be Properly Modified for your own location and circumstances. (Hint: If in doubt it's usually safer to include unneeded clauses than to leave out necessary ones. . . . but it's even safer to consult a competent source or use current, state specific ones like ours mentioned below.) Also, we urge people (and lawyers too) to read our Relying On Legal Info FAQ.

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APPLICATION FOR EMPLOYMENT

For Personnel use only

Employment Form

Last Name: _______________________

First: _________________ MI: ___

Date of Application: _________________

Street Address: ______________________________________

City:_________________State:_________ZIP:____________

Type(s) of Work Desired:

_____________________________________________________

Social Security number:______________________________

Home telephone: _________________

Work telephone: _________________

How Were You Referred To Us? (Circle only one.)

A By Your College
B Advertisement
C Employment Agency
D By an Employee
If So, Give Name: ________________________________
E Open house
F Walk-in
G Other

Please Read Carefully And Complete By Printing In Ink Or Typing.

An Equal Opportunity Employer We are an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose.

Provide All Information Requested.

Your complete application form will be maintained in our active files for six (6) months from the date of application. You may submit a new application at any time.

EMPLOYMENT RECORD

Starting with present or most recent, list all previous employers. Include self-employment and summer and part-time jobs. If more space is required, please continue on a separate sheet. You may attach a resume, but complete this application as well.

Last Or Present Company:

____________________________________________________________________

Type of Business:

____________________________________________________________________

Type or Classification of Job:

____________________________________________________________________

Street Address:______________________________________

City:_________________State:_________ZIP:____________

Phone number:_________________

Brief Description of Job Duties:

____________________________________________________________________

Supervisor's Name:__________________________________

Phone number:_________________

Base salary:__________________

Dates worked: From___________ To____________

Reason for leaving:

____________________________________________________________________

Last or Present Company:

___________________________________________________

Type of Business:

___________________________________________________

Type or Classification of Job:

___________________________________________________

Street Address:______________________________________

City:_________________ State:_______ ZIP:____________

Phone number:_________________

Brief Description of Job Duties:

___________________________________________________

Supervisor's Name:

___________________________________________________

Phone number:_________________

Base salary:_________________

Dates worked: From _____________ To _______________

Reason for Leaving:

___________________________________________________

EDUCATIONAL HISTORY

High School:

School Name: _____________________________________________

Location (city, state): __________________________________

Major Course or Subject:__________________________________

Dates Attended: From _____________ To _______________

Graduated: Yes ____________ No ___________

Degree: __________________________________

Technical/Trade (after high school)

School Name: _____________________________________________

Location (city, state): __________________________________

Major Course or Subject:__________________________________

Dates Attended: From _____________ To _______________

Graduated: Yes ____________ No ___________

Degree: __________________________________

College (list all attended)

School Name: _____________________________________________

Location (city, state): __________________________________

Major Course or Subject:__________________________________

Dates Attended: From _____________ To _______________

Graduated: Yes ____________ No ___________

Degree: __________________________________

School Name: _____________________________________________

Location (city, state): __________________________________

Major Course or Subject:__________________________________

Dates Attended: From _____________ To _______________

Graduated: Yes ____________ No ___________

Degree: __________________________________

Other education/training

School Name: _____________________________________________

Location (city, state): __________________________________

Major Course or Subject:__________________________________

Dates Attended: From _____________ To _______________

Graduated: Yes ____________ No ___________

Degree: __________________________________

School name: _____________________________________________

Location (city, state): __________________________________

Major Course or Subject:__________________________________

Dates Attended: From _____________ To _______________

Graduated: Yes ____________ No ___________

Degree: __________________________________

OUTSIDE ACTIVITIES

(Exclude those indicating race, color, religion, sex, national origin, age, or handicap.) Professional memberships, certificates, or licenses held

___________________________________________________

___________________________________________________

___________________________________________________

Past and Present Civic or Cultural Activities (include offices held)

___________________________________________________

___________________________________________________

Principal Hobbies

___________________________________________________

___________________________________________________

SPECIAL SKILLS

To be Completed by Applicant for Office/Clerical Work

Typing: Yes____ Words per Minute: _________ No____

Dictation: Yes____ Words per minute: _________ No____

To be Completed By Applicant for Shop/Plant Work

Type of Machines Operated:

___________________________________________________

___________________________________________________

Years Experience: ________

Computer Skills

Hardware:

___________________________________________________

Software:

___________________________________________________

Please list Other Skills and/or Equipment/Language Experience You Have Acquired:

___________________________________________________

___________________________________________________

List Other Shop/Production Skills:

___________________________________________________

___________________________________________________

Served Apprenticeship:

Yes_______ Type: __________________________________

No_______

MILITARY RECORD

Branch of Service

___________________________________________________

From _____________ To ____________

Present Military Affiliation:

None____ Reserve (active)_____ Reserve (inactive)______

Kinds of Training and Duty While in Service:

___________________________________________________

___________________________________________________

PROFESSIONAL/WORK REFERENCES

List two past supervisors and one person who is not related to you who have knowledge of your qualifications for the position for which you are applying.

Name: ___________________________________________________

Title/Relationship: _____________________________________

Street Address:______________________________________

City:_________________State:_________ZIP:____________

Phone no. (include area code)______________________

Occupation: _______________________________________

May We Contact Your Present Employer?

Yes ________ No _________

Wage or Salary Required: _________________

Date Available: _________________

I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company's service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company or myself.

___________________________________________________
Signature

Date: _________________

If any of your educational or employment records are under other than the above name, please provide other names.

___________________________________________________

___________________________________________________

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Relevant Laws We STRONGLY SUGGEST Checking Out
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