Employment Application

1. Instructions

Read the instructions carefully before starting.

IMPORTANT:Please ensure that you have completed all parts of the application. If you fail to complete all sections, your application will not be accepted. Any areas that do not apply to you, please enter N/A (not applicable).

1. Applicant Information

Include personal information requested. If you are unsure about salary, write or type "open" or "negotiable."

Full Name:	Smith	Pat	M	Date:	6/21/2021
	Last	First	M.I.

Address:	1234 Main Street
	Street Address	Apartment/Unit #

	Anytown	CA	90023
	City	State	ZIP Code

Date Available:

Desired Salary:

$

Position Applied for:

Are you a citizen of the United States?

YES

NO

If not, are you authorized to work in the U.S.?

YES

NO

Have you ever worked for this company?

YES

NO

If yes, when?

Have you ever been convicted of a felony?

YES

NO

If yes, explain:

1. Education

Provide schools, dates attended, and degrees earned. If you are still in school, provide your expected graduation month and year.

High School:

Address:

From:

To:

Did you graduate?

YES

NO

Diploma:

College:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

Other:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

1. References

Provide three professional references who are not your relatives or friends.

Please list three professional references.

Full Name:		Relationship:
Company:		Phone:
Address:
Full Name:		Relationship:
Company:		Phone:
Address:
Full Name:		Relationship:
Company:		Phone:
Address:

1. Previous Employment

Provide details requested about each job. Start with the most recent and work backward.

Company:		Phone:
Address:		Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?	YES	NO

Company:		Phone:
Address:		Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?	YES	NO

Company:		Phone:
Address:		Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

1. Military Service

Provide branch, rank, and time served.

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

7. Disclaimer and Signature

Your signature agreeing that the information provided is true.

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature:

Date: