Application for Employment (Sample)

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Section 1: General Information Section 2: Type of work
desired
Section 3: Education
Section 4: Skills Section 5: Activities & Professional
Associations
Section 6: Working History
Section 7: Others

Section 1: General Information

NOTE:  (The required fields are marked *)

General
Information

*Last Name
 

*Email Address

*First Name


 Social Security
-
-
Middle Name

Home Telephone
() -

*Address 1
Address 2
*City
*State
*Zip

*Are you a U.S. citizen or permanent resident?
Yes
No

Note:
  Proof of U.S. citizenship or immigration status and employment eligibility are required upon employment.

If no, are you legally eligible for employment in the U.S.(H-1 visa, etc.)?
Yes
No
Do you have a valid drivers license if required for the position you are seeking?
Yes
No
If yes, please give State/License Number:
State
License No.
*Have you ever been convicted of a felony?
Yes
No

A conviction of a felony will not automatically preclude you from employment.

If yes, please explain:

 

Section 2: Type of Work You Desired

Type
of
Work
Desired

Complete all information where applicable

*Indicate the job reference number(s) and title(s) of the position(s) for which you are applying. A reference number must be specified otherwise your application will not be considered.
  Job Reference Number and Title
1)
2)
3)
 
How did you learn about this job?

I will accept 
full-time employment 
part-time employment.
temporary employment 

Employee Referral:
Name - 

Other Source:
Name - 

*Salary Requirements:
$ weekly
monthly
yearly

Date Available:
(MM/DD/YY)

On occasion, hours in excess of the regular working hours may be required.  I agree to this as a condition of employment.
Yes
No
If No, Please Explain

Section 3: Education

Education

High School Name
Course of Study
Address
G.P.A.
City
Check Years Completed
4
State
    
Zip
Did you graduate? 
Yes  No 
If No, Please Respond.
GED? 
Yes  No 
If No, Please Explain
College Name
Course of Study
Address
G.P.A.
City
Check Years Completed
4
State
Zip
Did you graduate? 
Yes  No
  List Diploma or Degree

If Other, Please Explain
Additional College Name
Course of Study
Address
G.P.A.
City
Check Years Completed
4
State
Zip
Did you graduate? 
Yes  No
  List Diploma or Degree

If Other, Please Explain
Trade School/Business College Name
Course of Study
Address
G.P.A.
City
Check Years Completed
4
State
Zip
Did you graduate? 
Yes  No
  List Certification or Degree

Section 4: Skills

Skills

Typing:

Speed  WPM
Data Entry  KSPH
Dictation 
Office Machines:
Personal Computer
Fax Machine
Copier
Printer
Calculator
Terminal
Other
Microsoft® Products:
Word®
Excel®
Outlook®
Access®
PowerPoint®
Publisher®
Project®
Other
Please list other skills:

Section 5: Activities & Professional Associations

  Omit any organizations which would indicate reference to age, sex, race, religion, color, national origin, or disability.  Professional organizations, including offices held:

Activities / Professional Associations

Activities
Professional Associations
Certifications
Licenses
Others
Designations

Section 6: Working History

Work
History

Have you ever worked in our company and/or affiliate?
Yes  No
Date
Location(s)
Have you ever been employed under a different name?
Yes
No
If yes, other name
May we contact your present employer?
Yes  No

List prior employers below, starting with the most recent.

Employer:   
Supervisor: 
Address 1:       
Address 2:  
City:            State:
Telephone:  Zip:   
Date Employed:
From (Mo/Year)
To (Mo/Year)
Basic Salary/Wage:
Start $ Week  Month   Annual
End $ Week  Month   Annual
Position:
County of Residence:
Nature
of
Duties:
Reason
for
Leaving:

Employer:   
Supervisor: 
Address 1:       
Address 2:  
City:            State:
Telephone:  Zip:   
Date Employed:
From (Mo/Year)
To (Mo/Year)
Basic Salary/Wage:
Start $ Week  Month   Annual
End $ Week  Month   Annual
Position:
County of Residence:
Nature
of
Duties:
Reason
for
Leaving:

Employer:   
Supervisor: 
Address 1:       
Address 2:  
City:            State:
Telephone:  Zip:   
Date Employed:
From (Mo/Year)
To (Mo/Year)
Basic Salary/Wage:
Start $ Week  Month   Annual
End $ Week  Month   Annual
Position:
County of Residence:
Nature
of
Duties:
Reason
for
Leaving:

Employer:   
Supervisor: 
Address 1:       
Address 2:  
City:            State:
Telephone:  Zip:   
Date Employed:
From (Mo/Year)
To (Mo/Year)
Basic Salary/Wage:
Start $ Week  Month   Annual
End $ Week  Month   Annual
Position:
County of Residence:
Nature
of
Duties:
Reason
for
Leaving:

Section 7: Others
Please provide any additional information you think would be helpful to us in considering you for employment.

Pre-Employment Background Verification Statement
READ  CAREFULLY  BEFORE  SUBMITTING  APPLICATION

By submitting this application, I certify that answers given herein are true and complete.  False or misleading information discovered in the application process may result in the rejection of the application.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, including verification of all statements regarding my employment, education and criminal history.  I release from liability all persons, companies and corporations supplying such information and agree to indemnify company mentioned against any liability which might result from making such an investigation.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with company mentioned is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time and with or without notice.

In the event of employment, I understand that false or misleading information given in my application, interview(s), or any supplemental information process may result in discharge.  I understand also, that I am required to abide by all rules and regulations of the company mentioned.

AA/EOE/ADA/V/M/F

Signature: __________________________________   Date: _________________________________
(Signature required upon offer of employment)
 

Acknowledgement

I acknowledge and reaffirm that the information submitted to the company with respect to my employment application, including any  supporting materials, is complete and accurate.  I understand that submitting false or incomplete information could result in my termination. I understand that if I am hired by the company, I will be required to verify the accuracy of this information.  Submitting false or incomplete information could result in my termination.  I also acknowledge that while the company uses its best efforts to ensure the confidentiality of the information I send, it can guarantee that third parties will not, without the company's consent, gain access to this database.  The company will try its best to guarantee absolute privacy of this information.

Signature: __________________________________   Date: _________________________________
(Signature required upon offer of employment) 

 

Your application will be considered for the position(s) you indicated at below. If you wish to be considered for positions with only us or only our affiliations, please check the appropriate option below.  

Only our company.    Only our affiliations

 

 

 

Resume

You may submit your resume along with the online application. If you have an existing  resume, you may cut and paste it here in text format.