· Application for Employment Form
Last Name: _______________________
First:_________________MI:___
Date of Application: _________________
Street Address:
_____________________________________
City:_____________State:_______ZIP:____________
Type(s) of Work Desired:_______________________
_______________________________________________
Social Security number:_____________________
Home telephone: _________________
Work telephone: _________________
Please Read Carefully And Complete By Printing In Ink Or Typing.
We are an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose.
EMPLOYMENT RECORD
Starting with present or most recent, list all previous employers. Include self-employment and summer and part-time jobs.
Last Or Present Company:_____________________________
Street Address:______________________________________
City:_________________State:_________ZIP:______
(Page 2)
Phone number:_________________
Brief Description of Job Duties:_______________
_______________________________________________
Supervisor’s Name:__________________________________
Phone number:_________________
Base salary:__________________
Dates worked: From___________ To____________
Last or Present Company:_____________________________
Street Address:______________________________________
City:_________________ State:_______ ZIP:____________
Phone number:_________________
Brief Description of Job Duties:_________________________________
Supervisor’s Name:___________________________________
Phone number:________________
Base salary:_________________
Dates worked:
From _____________ To _______________
EDUCATIONAL HISTORY
School Name: ________________________________________
Location (city, state): _____________________________
(Page 3)
Dates Attended:
From _____________ To _______________
Graduated: Yes ____________ No ___________
Technical/Trade (after high school) OR College
School Name: ________________________________________
Location (city, state): _____________________________
Dates Attended:
From _____________ To _______________
Graduated: Yes ____________ No ___________
Degree: __________________________________
SPECIAL SKILLS
To be Completed for Shop/Plant Work
Type of Machines Operated:___________________________
Years Experience: ________
List Other Shop/Production Skills:________________________________________
_______________________________________________
PROFESSIONAL/WORK REFERENCES
List one person who has knowledge of your qualifications for the position for which you are applying.
Name: _______________________________________________
Phone no. (include area code)______________________
Occupation: _______________________________________
(Page 4)
May We Contact Your Present Employer?
Yes ________ No _________
Wage or Salary Required: _________________
Date Available: _________________
I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company’s service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company or myself.
Signature:___________________________
Date: _________________