Basic Application Form for Employment

APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
Date Social Security Number:
Name
Street Address
City/State/Zip
Phone Referred by:
Are you at least 18 years of age? Yes No
Are you a U.S. Veteran?
DESIRED EMPLOYMENT
Full Time Part Time
Position:
Date you can start:
Desired Salary:
Present Employment:
May We Contact Your Present Employer?
Supervisor: Phone:
EDUCATION
School Years Date Subjects
Level Attended* Graduated* Studied
High School
FORMER EMPLOYERS
Date
Month and Year Salary Position Reason for Leaving
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
HAVE YOU EVER BEEN CONVICTED OF A CRIME, OTHER THAN MINOR TRAFFIC OFFENSES? No Yes
Date: Signature:
Name and
Location of School
Name and
Location of Employer
*The Age Discrimination in Employment Act prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than age 70.
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were
committed, sentence(s) imposed, and type(s) of rehabilitation.
I certify that the information contained in this application is accurate and correct. I understand that any omission or erroneous information may be grounds for dismissal. I
authorize the references listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or
otherwise, and release all parties from all liability that may result from furnishing the same to you. These policies do not create any promises or contractual obligations
between this company and its employees. My employment is at will, which means I am free to terminate my employment at any time, for any reason, with or without cause,
and the company has the same right.
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