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Sample Employment Application Form

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE







APPLICATION FOR EMPLOYMENT



PLEASE COMPLETE PAGES 1-5.

DATE

Name


How long

Social Security No. _______ – _____ – _________

Telephone ( )



Position applied for (1)


and salary desired (2)

(Be specific)

Days/hours available to work

No Pref Thur

Mon Fri

Tue Sat

Wed Sun

How many hours can you work weekly? Can you work nights?



TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION
(Complete mailing address)


NUMBER OF YEARS COMPLETED

MAJOR & DEGREE




HAVE YOU EVER BEEN CONVICTED OF A CRIME? No Yes




PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE







APPLICATION FOR EMPLOYMENT




DO YOU HAVE A DRIVER’S LICENSE? Yes No


Have you had any accidents during the past three years?

How many?

Have you had any moving violations during the past three years?

How Many?




OFFICE ONLY








Personal Yes PC

Computer No Mac

Other

Skills




Please list two references other than relatives or previous employers.

Name

Name



An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.






PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE







APPLICATION FOR EMPLOYMENT




MILITARY









Work Experience

Please list your work experience for the past five years beginning with your most recent job held.
If you were self-employed, give firm name.
Attach additional sheets if necessary.







Name of employer
Address


Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number





From

To

Start

Final




Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.






Name of employer
Address


Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number





From

To

Start

Final




Your Last Job Title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.







PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE







APPLICATION FOR EMPLOYMENT

Work experience

Please list your work experience for the past five years beginning with your most recent job held.
If you were self-employed, give firm name.
Attach additional sheets if necessary.







Name of employer
Address


Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number





From

To

Start

Final




Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.




Name of employer
Address


Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number





From

To

Start

Final




Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.









If not, who did?



PLEASE READ CAREFULLY

APPLICATION FORM WAIVER


In exchange for the consideration of my job application by ___________________ (hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of , or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Signature of applicant__________________________________________ Date: ___________________


This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.


Thank you for completing this application form and for your interest in our business.


PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE










POST EMPLOYMENT INFORMATION FORM

TO BE COMPLETED AFTER EMPLOYEE HAS BEEN HIRED

Height ______ ft. ______ in. Weight __________ Birth date _______________

Married Yes No If married, how long? _____ Single Separated Divorced Widowed

Full name of spouse Occupation

Name of company Telephone ( )

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

Name Telephone ( )

Address Relationship

FOR INSURANCE PURPOSES ONLY: LIST ALL DEPENDENTS


NAME

RELATIONSHIP

BIRTH DATE

SSN

























































TO BE COMPLETED







BY EMPLOYER




Date of employment Job title Dept.

Location Rate of pay Full-time Part-time Salaried

Applicant’s signature acknowledging above information

Drug test confirmation number

Name of person verifying information

Name of person authorizing employment

Applicant Selection Criteria Record

JOB TITLE


CANDIDATES CONSIDERED (INCLUDING MINORITIES AND FEMALES)


NAME

MALE/

FEMALE

ETHNIC

CODE*

ON LAB SECTION/ OFF LAB

















































*ETHNIC CODES: 1-BLACK, 2-ORIENTAL, 3-HISPANIC, 4-AMERICAN INDIAN, 0-OTHER

CANDIDATE SELECTED


NAME

MALE/

FEMALE

ETHNIC

CODE

SOURCE













SELECTION CRITERIA




















REASONS CANDIDATE SELECTED WAS PREFERABLE TO OTHERS




















ORIGINATOR'S SIGNATURE

DATE


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