State Form 48245 Master Job Application - Indiana

Form State48245 or the "Master Job Application" is a form issued by the Indiana Secretary of State.

Download a fillable PDF version of the Form State48245 down below or find it on the Indiana Secretary of State Forms website.

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Reset Form
The information contained on this form is CONFIDENTIAL according to
MASTER JOB APPLICATION
470 IAC 1-2-7, 470 IAC 1-3-1, and 470 6-1-1.
State Form 48245 (R4 / 6-12) / IMP 0021
PERSONAL INFORMATION
Are you a U.S. citizen?
If No, are you legally allowed to work in the U.S.?
Registration number
Yes
No
Yes
No
Date (month, day, year)
Social Security number (Please enter last four (4) digits only)
XXX-XX- ______
Name (last, first, middle)
Present address (number and street, city, state, and ZIP code)
Permanent address (number and street, city, state, and ZIP code)
Primary telephone number
Alternate telephone number
(
)
(
)
Have you ever been convicted of a felony?
If Yes, explain in full. (Attach additional sheet, if necessary.)
Yes
No
If Yes, what type?
Do you have a valid driver's license?
Yes
No
Operator
Commercial
Chauffeur
EMPLOYMENT DESIRED
Salary desired
Position for which you are applying
Date you can start (month, day, year)
Are you currently employed?
If so, may we contact your present employer?
Have you ever applied to this company before?
Where?
When?
Work preference
Full-time
Part-time
No preference
EDUCATION
SUBJECTS STUDIED AND
DID YOU
CHECK LAST
CERTIFICATE, DIPLOMA, DEGREE
TYPE OF SCHOOL
NAME AND LOCATION OF SCHOOL
GRADUATE?
YEAR COMPLETED
RECEIVED
Yes
1
2
3
4
ELEMENTARY/
No
MIDDLE SCHOOL
5
6
7
8
Yes
HIGH SCHOOL
9
10
11
12
No
Yes
COLLEGE
1
2
3
4
No
TRADE, BUSINESS OR
Yes
1
2
3
4
CORRESPONDENCE SCHOOL
No
Describe any special studies, skills, and experiences, or foreign language abilities that could enhance your job performance.
PHYSICAL RECORD (Do you have any physical condition which may limit your ability to perform the job for which you are applying?)
This question is voluntary, and any answers will be kept confidential.
Page 1 of 2
Reset Form
The information contained on this form is CONFIDENTIAL according to
MASTER JOB APPLICATION
470 IAC 1-2-7, 470 IAC 1-3-1, and 470 6-1-1.
State Form 48245 (R4 / 6-12) / IMP 0021
PERSONAL INFORMATION
Are you a U.S. citizen?
If No, are you legally allowed to work in the U.S.?
Registration number
Yes
No
Yes
No
Date (month, day, year)
Social Security number (Please enter last four (4) digits only)
XXX-XX- ______
Name (last, first, middle)
Present address (number and street, city, state, and ZIP code)
Permanent address (number and street, city, state, and ZIP code)
Primary telephone number
Alternate telephone number
(
)
(
)
Have you ever been convicted of a felony?
If Yes, explain in full. (Attach additional sheet, if necessary.)
Yes
No
If Yes, what type?
Do you have a valid driver's license?
Yes
No
Operator
Commercial
Chauffeur
EMPLOYMENT DESIRED
Salary desired
Position for which you are applying
Date you can start (month, day, year)
Are you currently employed?
If so, may we contact your present employer?
Have you ever applied to this company before?
Where?
When?
Work preference
Full-time
Part-time
No preference
EDUCATION
SUBJECTS STUDIED AND
DID YOU
CHECK LAST
CERTIFICATE, DIPLOMA, DEGREE
TYPE OF SCHOOL
NAME AND LOCATION OF SCHOOL
GRADUATE?
YEAR COMPLETED
RECEIVED
Yes
1
2
3
4
ELEMENTARY/
No
MIDDLE SCHOOL
5
6
7
8
Yes
HIGH SCHOOL
9
10
11
12
No
Yes
COLLEGE
1
2
3
4
No
TRADE, BUSINESS OR
Yes
1
2
3
4
CORRESPONDENCE SCHOOL
No
Describe any special studies, skills, and experiences, or foreign language abilities that could enhance your job performance.
PHYSICAL RECORD (Do you have any physical condition which may limit your ability to perform the job for which you are applying?)
This question is voluntary, and any answers will be kept confidential.
Page 1 of 2
EMPLOYMENT HISTORY (List your last four employers starting with the most recent)
Name of employer and address:
Position title, duties, and skills:
Start date (mm/dd/yyyy) End date (mm/dd/yyyy)
Reason for leaving:
Pay:
Per:
Name of supervisor
Telephone number
(
)
$
Name of employer and address:
Position title, duties, and skills:
Start date (mm/dd/yyyy) End date (mm/dd/yyyy)
Reason for leaving:
Pay:
Per:
Name of supervisor
Telephone number
(
)
$
Name of employer and address:
Position title, duties, and skills:
Start date (mm/dd/yyyy)
End date (mm/dd/yyyy)
Reason for leaving:
Pay:
Per:
Name of supervisor
Telephone number
(
)
$
Name of employer and address:
Position title, duties, and skills:
Start date (mm/dd/yyyy)
End date (mm/dd/yyyy)
Reason for leaving:
Pay:
Per:
Name of supervisor
Telephone number
(
)
$
MILITARY SERVICE
Branch of service
Period of active duty
Rank at discharge
From
To
Describe duties / specialized training.
ORGANIZATIONS AND VOLUNTEER ACTIVITIES (List responsibilites and offices)
REFERENCES (Give below the names of three persons not related to you, whom you have known at least one year)
Name
Address
Telephone Number
Business
Years Acquainted
I authorize investigation of all statements contained in this application. I understand that misrepresentation of facts called for is cause for dismissal. Further, I
understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any
time without any previous notice.
Signature
Date (month, day, year)
Page 2 of 2

Download State Form 48245 Master Job Application - Indiana

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