Application Sample

Applicant Information

Applicant Name _____________________
Home Phone _______________________
Other ____________________________
Email Address _____________________

Current Address:
Number and street ____________________
City ________________________________
State & Zip ____________________________

How were you referred to Company?:___________________________

Employment Positions

Position(s) applying for:________________________________

Are you applying for:

• Temporary work – such as summer or holiday work? [ ] Y or [ ] N
  
• Regular part-time work? [ ] Y or [ ] N
  
• Regular full-time work? [ ] Y or [ ] N

What days and hours are you available for work?___________________________________________

If applying for temporary work, when will you be available? ___________________________________________

If hired, on what date can you start working? ___ / ___ / ___

Can you work on the weekends? [ ] Y or [ ] N

Can you work evenings? [ ] Y or [ ] N

Are you available to work overtime? [ ] Y or [ ] N

Salary desired: $________________________________

Personal Information:

Have you ever applied to / worked for Company before? [ ] Y or [ ] N
If yes, please explain (include date): ________________________

Do you have any friends, relatives, or acquaintances working for Company? [ ] Y or [ ] N
If yes, state name & relationship: ________________________________

If hired, would you have transportation to/from work? [ ] Y or [ ] N

Are you over the age of 18? (If under 18, hire is subject to verification of minimum legal age.) [ ] Y or [ ] N

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? [ ] Y or [ ] N

If hired, are you willing to submit to and pass a controlled substance test? [ ] Y or [ ] N

Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? [ ] Y or [ ] N

If no, describe the functions that cannot be performed
_____________________________________________________________

(Note: Company complies with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)

Have you ever been convicted of a criminal offense (felony or misdemeanor)? [ ] Y or [ ] N

If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case.________________________________________________________________

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Education, Training and Experience

High School:
School name: ________________________
School address:________________________
School city, state, zip:________________________________

Number of years completed: _______________
Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: _______________

College / University:
School name: __________________________
School address:________________________
School city, state, zip:________________________________

Number of years completed: ________
Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: __________________

Vocational School:
Name: ________________________
Address:______________________
City, state, zip:________________________________

Number of years completed: ________
Did you graduate? [ ] Y or [ ] N
Degree / diploma? : __________________

Military:
Branch: ________________________
Rank in Military:________________________
Total Years of Service: ________
Skills/duties: ________
Related details:________________________________