SAMPLE

YOUR COMPANY NAME HERE

Employment Application

An Equal Opportunity Employer

Please Print in Ink /

FOR COMPANY USE ONLY

To Start (Date): / Emp. #
Pay Rate:
Date: / $ / Per / Commission / Yes
No
Position applying for: / Location:
Position: / Job #
Location applying to: / Supervisor:
Hired By:
Hire Source:
Pay Rate:
Check / Full Time / Part Time / Regular / Temporary
Name: First Middle Last
/ Social Security #
Telephone #
Address:
How were you referred
to our company? / Ad / Agency / Relative / Friend / Walk-in / Other
Have you been employed by us before? / No / Yes / Dates: / Locations:
Have you ever been convicted of a criminal act? / No / Yes / If yes, please explain: (Conviction will not automatically exclude you from employment)
Are you legally allowed to work in the U.S.? / No / Yes / If hired, federal law requires documentation verifying your identity and legal authorization to work in the U.S.

EDUCATION

NAME

/ CITY / STATE /

# of YRS

/

GRADUATED

/
DEGREE/MAJOR
High School:
College/University:
Trade School:
Other:
List any other education, training, special skills or certificates that you possess related to the job for which you are applying:
List any machines or equipment that you are qualified and experienced at operating:
List all computer software programs and systems with which you are experienced:
Salary Desired:
May we contact your present employer? / No / Yes / (if yes) Phone #:

Employment Application –2-

WORK HISTORY

Start with your most recent employment, including self-employment, military and volunteer experience.
This section must be completed even if submitting a resume.
Employer: / Telephone:
Address:
Employed From (Mo/Yr): / To (Mo/Yr): / Income Starting: / Income Ending: / Title:
Job Duties:
Reason for Leaving:
Employer: / Telephone:
Address:
Employed From (Mo/Yr): / To (Mo/Yr): / Income Starting: / Income Ending: / Title:
Job Duties:
Reason for Leaving:
Employer: / Telephone:
Address:
Employed From (Mo/Yr): / To (Mo/Yr): / Income Starting: / Income Ending: / Title:
Job Duties:
Reason for Leaving:
Employer: / Telephone:
Address:
Employed From (Mo/Yr): / To (Mo/Yr): / Income Starting: / Income Ending: / Title:
Job Duties:
Reason for Leaving:

IMPORTANT-READ BEFORE SIGNING

I certify that the information in this application is true and complete. Any false statements, concealments or omissions are grounds for refusal
to hire or immediate dismissal, if hired.
I authorize (YOUR COMPANY NAME) to investigate and verify the information contained in this application which may include contacting
my schools and former employers, and for (YOUR COMPANY NAME)to keep and preserve such records. I understand that, if hired, my employment is at will and may be terminated without cause and without notification by either the company or me. THIS APPLICATION
DOES NOT CONSTITUTE A CONTRACT FOR EMPLOYMENT, EXPRESS OR IMPLIED. If employed, I agree to adhere to the
company’s rules and regulations.
Signature
/ Date