Job Application Form - Sample

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Sample Application Form
Instructions: Please complete all of the
Today’s Date: _________________
the questions accurately and fully. Attach
additional sheets if needed.
Name: ________________________________________
Driver License: State ____ Number__________________________
Street address: _____________________________
City: __________________________ State: ______ Zip: _________
How long at current address: _____________
Phone: Home (______) _______________________
Work (______) _______________________
Best Time to Contact You: _______________________
E-Mail Address: __________________________________________
Are you legally eligible to work in this country?
Note: If you are chosen for a paid position, you will be required to
____ Yes
____ No
show documents verifying your employment eligibility and identity to
complete the INS Form I-9 as required by the Immigration Reform
and Control Act.
Please list your addresses in the past five years:
______________________________________________
______________________________________________
______________________________________________
For what position are you applying? ___________________________________________________________________________
What interests you about the position for which you are currently applying? ___________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
What has prepared you for the position for which you are currently applying? _________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Employment history-
Please complete for your prior employers, covering the past ten years.
Dates of employment
Company name and
Immediate supervisor
(Start with most
address
name and phone
Position held
Reason for leaving
recent)
(City, State Zip)
number
position
Started ___/___/___
Ended ___/___/___
Started ___/___/___
Ended ___/___/___
Started ___/___/___
Ended ___/___/___
Started ___/___/___
Ended ___/___/___
Sample Application Form
Instructions: Please complete all of the
Today’s Date: _________________
the questions accurately and fully. Attach
additional sheets if needed.
Name: ________________________________________
Driver License: State ____ Number__________________________
Street address: _____________________________
City: __________________________ State: ______ Zip: _________
How long at current address: _____________
Phone: Home (______) _______________________
Work (______) _______________________
Best Time to Contact You: _______________________
E-Mail Address: __________________________________________
Are you legally eligible to work in this country?
Note: If you are chosen for a paid position, you will be required to
____ Yes
____ No
show documents verifying your employment eligibility and identity to
complete the INS Form I-9 as required by the Immigration Reform
and Control Act.
Please list your addresses in the past five years:
______________________________________________
______________________________________________
______________________________________________
For what position are you applying? ___________________________________________________________________________
What interests you about the position for which you are currently applying? ___________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
What has prepared you for the position for which you are currently applying? _________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Employment history-
Please complete for your prior employers, covering the past ten years.
Dates of employment
Company name and
Immediate supervisor
(Start with most
address
name and phone
Position held
Reason for leaving
recent)
(City, State Zip)
number
position
Started ___/___/___
Ended ___/___/___
Started ___/___/___
Ended ___/___/___
Started ___/___/___
Ended ___/___/___
Started ___/___/___
Ended ___/___/___
Volunteer experience
Organization
Duties
Dates
Contact
Phone
Educational history
Name of School
Address
(City, State Zip)
Type of School
Name of Program or
Program completed?
Degree
References
Address
Daytime Phone
How long have you
Relationship to
Reference Name
(City, State, Zip)
known this person?
You
Professional/Civic
Professional/Civic
Personal
Personal
Family member
Have you ever been accused of physically, sexually or emotionally abusing a child or an adult? ________________________
If yes, please explain. _______________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Acknowledgment, Release, and Signature for Inclusion in Application
or with Church Deployment Office Form
To the best of my knowledge, the information contained in this application is complete and
accurate. I understand that providing false information is grounds for not hiring me or choosing
me for a volunteer position or for my discharge if I have already been hired or chosen. I
authorize any person or organization, whether or not identified in this application, to provide any
information concerning my previous employment, education, credit history, driving record,
criminal conviction record, sexual offender registry or other qualifications for my employment or
volunteering. I also authorize ___________________ [Parish or Institution] to request and
receive such information.
If hired or chosen, I agree to be bound by ____________________________ [Parish or
Institution’s] policies and procedures, including but not limited to its Policies for the Prevention
of Sexual Exploitation of Adults and Code of Conduct for Persons Having Pastoral
Relationships.
I understand that these may be changed, withdrawn, added to or interpreted at any time at the
______________________ [Parish or Institution’s] sole discretion and without prior notice to
me.
I also understand that my employment or volunteering may be terminated, or any offer or
acceptance of employment or volunteering withdrawn, at any time, with or without cause, and
with or without prior notice at the option of _____________________ [Parish or Institution] or
myself.
Nothing contained in this application or in any pre-employment or pre-volunteering
communication is intended to or creates a contract between myself and
____________________________ [Parish or Institution] for employment, volunteering or the
providing of any benefit.
I have read and understand the above provisions.
Signature _______________________________________
Date _______________
Print Name _____________________________________
Parish or Institution _________________________________________________________

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