Employment application

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Use this job application to prepare to complete Your Resume.

Date

First Name

Middle Initial

Last Name

Address Line 1

Address Line 2

City

State

ZIP Code

Phone

Eligibility/Position/Salary

Are you 18 years or older?

Yes No

Are you legally authorized to work in the United States?

Yes No

What position are you applying for?

Enter how many hours per week you desire to work

If hired, would you be able to start immediately?

Yes No

If no, when would you be able to start?

What is your desired salary?

Are you employed now?

Yes No

If yes, may we inquire of your present employer?

Yes No

Have you ever applied to this company before?

Yes No

If yes, when?

If yes, where?

Who referred you?

High School Name

High School Location

No of years attended

Did you graduate or earn a high school equivalency?

Yes No

Subjects studied?

College or Other Higher Education Institution Name

Location

No of years attended

Did you graduate?

Yes No

Subjects studied?

Graduate School Name

Graduate School Location

years attended

1 2 3 4 5+

Did you graduate?

Yes No

Subjects studied?

Subjects of special study?

Special Skills

Activities (athletic, civic, volunteer, etc.)

Are you a U.S. Military Veteran?

Yes No

Employment History

Address

Start Date

End Date

Salary

Position

Reason for leaving

Which of your past jobs did you like best?

What did you like most about that job?

Have you ever been dismissed or forced to resign from any employment?

Yes No

If you answered “yes” to the previous question, please explain.

References Reference #1

Name

Address

Years Acquainted

References Reference #2

Name

Address

Business

Years Acquainted

References Reference #3

Name

Address

Business

Years Acquainted

Schedule Preferences

Are you willing to work a flexible schedule including evenings, weekends, holidays and overtime as, and if requested?

Yes No

What type of schedule are you interested in?

Full-Time Part-Time, less than 30 hours Part-Time, less than 20 hours No Evenings No Weekends No Holidays.

Criminal History

Have you been convicted of a felony crime or theft-related misdemeanor within the last 5 years?

Yes No

If you answered “yes” to the previous question, please

Your E-mail

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