EMPLOYMENT APPLICATION FORM
Personal Information
First Name: __________________Middle Name: __________________Last Name: _________________
Street Address: _________________________________ City, State, Zip Code: _____________________
Phone Number: (___) ______________________ Email Address: ________________________________
Have you ever applied to / worked for [Our Company] before? [ ] Yes or [ ] No
If yes, please explain (include date): _______________________________________________________
Do you have any friends, relatives, or acquaintances working for [Our Company]? [ ] Yes or [ ] No
If yes, state name & relationship: __________________________________________________________
If hired, would you have transportation to/from work? [ ] Yes or [ ] No
Are you over the age of 18? [ ] Yes or [ ] No
If you are under the age of 18, do you have an employment/age certificate? [ ] Yes or [ ] No
If hired, would you be able to present evidence of your citizenship or proof of your legal right to work in
the United States/Canada/Australia? [ ] Yes or [ ] No
Have you been convicted of or pleaded no contest to a felony within the last five years? [ ] Yes or [ ] No
If yes, please describe the crime - state the nature of the crime(s), when and where convicted, and the
disposition (final settlement) of the case:
_____________________________________________________________________________________
If hired, are you willing to submit to a controlled substance test? [ ] Yes or [ ] No
Position and Availability
Position Applying For: ___________________________________________________________________
Desired Salary: $_______________________________________________________________________
Are you applying for:
Temporary work – such as summer or holiday work? [ ] Yes or [ ] No
Regular part-time work? [ ] Yes or [ ] No
Regular full-time work? [ ] Yes or [ ] No
If applying for temporary work, indicate your desired length of employment below:
Start date: ___ / ___ / ___ End date: ____ / ____ / ____
Days/Hours Available
Monday ___________
Tuesday ___________
Wednesday ________
Thursday __________
Friday ____________
Saturday __________
Sunday ___________
Hours Available: from _________________________________ to _______________________________
Are you available to work overtime? [ ] Yes or [ ] No
If hired, on what date can you start working? ________ / ________ / ________
Are you able to perform the essential functions of the job for which you are applying, either with /
without reasonable accommodation? [ ] Yes or [ ] No
If no, describe the functions that cannot be performed:
_____________________________________________________________________________________
_____________________________________________________________________________________
Education, Training and Experience
High School:
School Name: _________________________________________________________________________
School Address: ________________________________________________________________________
School City, State, Zip: __________________________________________________________________
Number of years completed: _____________________________________________________________
Did you graduate? [ ] Yes or [ ] No
Degree / Diploma earned: _______________________________________________________________
College / University:
School Name: _________________________________________________________________________
School Address:________________________________________________________________________
School City, State, Zip: __________________________________________________________________
Number of years completed: _____________________________________________________________
Did you graduate? [ ] Yes or [ ] No
Degree / Diploma Earned: _______________________________________________________________
Vocational School:
School Name: _________________________________________________________________________
School Address: ________________________________________________________________________
School City, State, Zip: __________________________________________________________________
Number of years completed: _____________________________________________________________
Did you graduate? [ ] Yes or [ ] No
Degree / Diploma earned: _______________________________________________________________
Military:
Branch: ______________________________________________________________________________
Rank in Military: _______________________________________________________________________
Total Years of Service: ___________________________________________________________________
Skills/Duties: __________________________________________________________________________
Related Details: ________________________________________________________________________
Skills and Qualifications: Licenses, Skills, Training, Awards______________________________________
_____________________________________________________________________________________
Do you speak, write or understand any foreign languages? [ ] Yes or [ ] No
If yes, list which languages(s) and how fluent you consider yourself to be: _________________________
Employment History:
You should be prepared to detail each position for the past two years and account for any gaps in
employment during that period.
Are you currently employed? [ ] Yes or [ ] No
If you are currently employed, may we contact your current employer? [ ] Yes or [ ] No
Name of Employer: _____________________________________________________________________
Name of Supervisor: ____________________________________________________________________
Telephone Number: ____________________________________________________________________
Business Type: _________________________________________________________________________
Address: _________________________________________________________City, State, Zip: ________
Length of Employment (Include Dates): ________________ Salary/Hourly Rate of Pay: ______________
Position & Duties: ______________________________________________________________________
Reason for Leaving: _____________________________________________________________________
Name of Employer: _____________________________________________________________________
Name of Supervisor: ____________________________________________________________________
Telephone Number:_____________________________________________________________________
Business Type: _________________________________________________________________________
Address:____________________________________________ City, State, Zip:_____________________
Length of Employment (Include Dates): ________________ Salary/Hourly Rate of Pay: ______________
Position & Duties: ______________________________________________________________________
Reason for Leaving: _____________________________________________________________________
May we contact this employer for references? [ ] Y or [ ] N
References:
List below two persons who have knowledge of your work performance within the last two years.
Professional references only:
1. First and Last Name: _____________________________________________________________
Telephone Number: _____________________________________________________________
Email Address: __________________________________________________________________
Address: _______________________________________________________________________
City, state, zip: __________________________________________________________________
Occupation: ___________________________________________________________________
Number of Years Acquainted: _____________________________________________________
2. First and Last Name: _____________________________________________________________
Telephone Number: _____________________________________________________________
Email Address: __________________________________________________________________
Address: _______________________________________________________________________
City, state, zip: __________________________________________________________________
Occupation: ____________________________________________________________________
Number of Years Acquainted: ______________________________________________________
Certification
I certify that the information contained in this application is true and complete. I understand that false
information may be grounds for not hiring me or for immediate termination of employment if I am
hired. I authorize the verification of any and all information listed above.
Signature: ___________________________________________ Date: ____________________________
INTERVIEW QUESTIONS
Tell Us About Yourself?
_____________________________________________________________________________________
_____________________________________________________________________________________
Discuss your educational background?
_____________________________________________________________________________________
Why Do You Want to Work at This Company?
_____________________________________________________________________________________
_____________________________________________________________________________________
Tell Us about a Time You Demonstrated Leadership Skills?
_____________________________________________________________________________________
What’s a Time You Disagreed with a Decision That Was Made at Work?
_____________________________________________________________________________________
Can You Explain Why You Changed Career Paths?
_____________________________________________________________________________________
What’s Your Current Salary?
_____________________________________________________________________________________
What Are Your Salary Requirements?
_____________________________________________________________________________________
What Do You Like to Do Outside of Work?
_____________________________________________________________________________________
What Should We Know That’s Not on Your Resume?
_____________________________________________________________________________________
