Application Form for Employment

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APPLICATION FOR EMPLOYMENT
Date ________________________
Directions: Type or print in blue or black ink. Answer all questions which are applicable. Please do not state “See Resume”.
PERSONAL INFORMATION
Last Name
First Name
Middle
Address
City
State
Zip
Phone
Day Phone (if Different)
Social Security Number
Fax Number
E-Mail Address
EMPLOYMENT INFORMATION
Position for which you are applying
Are you employed at the present time? ________ If yes, please complete the information below
Employer’s Name:
Employer’s Address:
1. How long have you been with this employer? __________ Present Salary:
2. If offered a position, when can you report for work? ____________________________
3. If hired can you show proof of your legal right to work in the U.S.?
Yes ____
No ____
4. Have you ever been dismissed, or asked to resign from any position?
Yes ____
No ____
5. Have you ever been convicted of a felony, or a misdemeanor which resulted in
Yes ____
No ____
imprisonment?
A yes answer to the above question does not necessarily disqualify an
applicant from employment.
If yes to number 4 or 5, please explain:
EDUCATION
Please list on the following lines all schools attended and any other pertinent information about your education.
School(s)
Subjects Studied (if applicable)
High School
College (Including dates attended)
APPLICATION FOR EMPLOYMENT
Date ________________________
Directions: Type or print in blue or black ink. Answer all questions which are applicable. Please do not state “See Resume”.
PERSONAL INFORMATION
Last Name
First Name
Middle
Address
City
State
Zip
Phone
Day Phone (if Different)
Social Security Number
Fax Number
E-Mail Address
EMPLOYMENT INFORMATION
Position for which you are applying
Are you employed at the present time? ________ If yes, please complete the information below
Employer’s Name:
Employer’s Address:
1. How long have you been with this employer? __________ Present Salary:
2. If offered a position, when can you report for work? ____________________________
3. If hired can you show proof of your legal right to work in the U.S.?
Yes ____
No ____
4. Have you ever been dismissed, or asked to resign from any position?
Yes ____
No ____
5. Have you ever been convicted of a felony, or a misdemeanor which resulted in
Yes ____
No ____
imprisonment?
A yes answer to the above question does not necessarily disqualify an
applicant from employment.
If yes to number 4 or 5, please explain:
EDUCATION
Please list on the following lines all schools attended and any other pertinent information about your education.
School(s)
Subjects Studied (if applicable)
High School
College (Including dates attended)
EMPLOYMENT EXPERIENCE (List most recent experience first)
Name & Address
Position(s) Held
Dates (Start - End)
REFERENCES
Name & Address (Include City, State, Zip)
Phone
Relationship
The following section is to be completed by applicant for an OFFICE POSITION:
Can you type? ___________
How many words per minute? __________
Computer Skills
Macintosh ____________
PC __________________
Please provide computer and software knowledge below:
I certify that all statements made herein and on the enclosed resume are true and correct to the best of my
knowledge. I authorize investigation of all statements herein recorded. I release from liability all persons and
organizations reporting information required by this application.
Signature
Date

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