General Employment Application


EMPLOYMENT APPLICATION

Applications are considered without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non‑job‑related medical condition or handicap.

PERSONAL INFORMATION:

Date ___________________                Start Date ____________________

(_) Full Time     (_)  Part Time     (_)  Temporary   Referral Source _________

Name: ___________________________________    D.O.B.: __________

Business Name: ________________________     Form of Entity: ________

Street Address: ________________________      Phone: _____________

City/State/Zip: ________________________       SSN: ______________

Are you a U.S. citizen?  (__) Yes   (__)  No   If no, what is your citizenship/residency status: __________________________________

Have you ever been convicted of or charged with a felony or misdemeanor:  (__) Yes    (__)  No    If yes, please explain details in full, including dates, details of offense(s) charged, jurisdiction and disposition of case: _________________________________________________________

_________________________________________________________

 Have you, or any person or entity with whom you have been associated with, filed for bankruptcy, been declared bankrupt or insolvent or been the subject of any receivorship proceedings within the last 7 years?

(__) Yes   (__) No

If Yes, please provide full details, including dates, places, amounts involved and disposition:

__________________________________________________________

 EDUCATION:

Schools/Colleges Attended:                                # Years      Year Grad   Degree

_______________________________        _____        _______     ______

_______________________________        _____        _______      ______

_______________________________        _____        _______      ______

 EMPLOYMENT/WORK EXPERIENCE: Start with your present or most recent position. Include military ser­vice assign­ments and volunteer activities. Exclude organization names that indicate race, color, religion, sex or nation­al origin.

Employer:  ________________________________________________ Job Title: _______________________    Supervisor: _______________

Street Address: ____________________________________________

City/State/Zip: ___________________________   Phone: __________

Describe Duties/Responsibilities/Accomplishments:

________________________________________________________

________________________________________________________

________________________________________________________

 Reason for Leaving: ________________________________________

Dates of Employment (Month/Year): From ___________   To  ________

Employer: _______________________________________________

Job Title: ____________________________   Supervisor: ___________

Street Address: _____________________________________________

City/State/Zip: ___________________________  Phone: ____________

Describe Duties/Responsibilities/Accomplishments:

_________________________________________________________

_________________________________________________________

_________________________________________________________

 Reason for Leaving: _________________________________________

Dates of Employment (Month/Year): From _________  To ___________

Employer: _________________________________________________

Job Title: ___________________    Supervisor: ____________________

Street Address: _____________________________________________

City/State/Zip: __________________________  Phone: _____________

Describe Duties/Responsibilities/Accomplishments:

_________________________________________________________

_________________________________________________________

_________________________________________________________

 Reason for Leaving: _________________________________________

Dates of Employment (Month/Year): From _________   To ___________

BUSINESS REFERENCES: Please provide individual and company names, position, addresses and phone numbers for 3 business references.

 

Name: _____________________   Company: _____________________

Street Address: _________________________  Position: ___________

City/State/Zip: __________________________ Phone: ____________

Name: _____________________   Company: _____________________

Street Address: __________________________ Position: ___________

City/State/Zip: __________________________ Phone: ____________

Name: ________________________  Company: __________________

Street Address: __________________________   Position: __________

City/State/Zip: __________________________  Phone: ____________


PERSONAL REFERENCES: Please provide names, addresses, phone numbers, relationship and how long known for 3 personal references.

Name: ___________________________  Relationship: ______________

Street Address: _________________________  How long: ____________

City/State/Zip: _________________________ Phone: _______________

Name: ___________________________    Relationship: _____________

Street Address: __________________________ How long: ___________

City/State/Zip: _________________________ Phone: ______________

Name: ___________________________    Relationship: _____________

Street Address: __________________________  How long: __________

City/State/Zip: __________________________  Phone: ____________

SPECIAL SKILLS: Describe any special skills or qualifications for this work: ____________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

 I CERTIFY that the above answers are true and complete to the best of  my knowledge. I authorize ___________________________________, to investigate any statement contained in this application, and to obtain a credit report on me (and my company if this application is for reselling by a company) as necessary to determine my qualifications. I understand that this application is not and is not intended to be any kind of contract or agreement. In the event of employment, I understand that any false or misleading information given in my application, correspondence, discussions or interview may result in immediate termination. I understand also, that I am required to abide by all rules, regulations and policies of ________________________________________.

Signed: ______________________________             Date: ____________

FOR ____________________      USE ONLY:__________________

Arrange Interview:   (__) Yes   (__)  No   Date: ____________

Place: ____________________________________________________

Remarks: __________________________________________________

__________________________________________________________

_________________________________________________________

 Approved:   (__) Yes   (__) No    Date: ___________________________

By: _______________________________________________________

State Specific Application Forms

—-For State Specific Application Forms you can download in Word Format go to

http://www.uslegalforms.com/applications/