Employment Application
Applicant Information
Full Name: / Date:Last / First / M.I.
Address:
Street Address / Apartment/Unit #
City / State / ZIP Code
Phone: / ( ) / E-mail Address:
Date Available: / Social Security No.: / Desired Salary: / $
Position Applied for:
Have you ever been convicted of a felony? / YES / NO
If yes, explain:
Education
High School: / Address:From: / To: / Did you graduate? / YES / NO / Degree:
College: / Address:
From: / To: / Did you graduate? / YES / NO / Degree:
References
How were you referred to us? ______For Students, List one teacher or advisor as a reference.
Full Name: / Subject
School / Phone: / ( )
Please List Previous Employment on the Reverse Side
Previous Employment
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
Disclaimer and Signature
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.
I understand that I may be asked to submit for drug screening before my employment and at any time during my employment. I also understand that I am responsible for the initial costs of these tests and will be reimbursed if the tests show negative usage. I further understand that results showing drug use will lead to my immediate dismissal.
Signature: / Date:
Interview Notes:
Personality / NeatnessOther Remarks