Fillable Printable Application for Employment Form Free
Fillable Printable Application for Employment Form Free
Application for Employment Form Free
Name of Applicant ______________________
ASPS/HRD-FA3.01 10/12 1 of 7
Arizona State Personnel System
APPLICATION FOR EMPLOYMENT
Completion of this form in no way constitutes an offer of employment. The information requested is
required to provide us with information necessary to consider you for the position for which you are
applying.
DATE OF APPLICATION _____________________________
PLEASE PRINT LEGIBLY OR TYPE ALL REQUESTED INFORMATION
Position for which you are applying _______________________________________________
___________________________________________________________________________________________________
Last Name First Name M.I.
__________________________________________________________________________________________
Street Address City State Zip Code
_______________________________________________ _________________________
Contact Phone Number(s) (include area code) Contact E-mail Address
_______________________________________________ _________________________
Alternate Phone Number(s) (include area code) State Agency Applying To
CONDITIONS OF CONSIDERATION FOR EMPLOYMENT
All information contained on the application is subject to verification. If applicable, the State of Arizona may
conduct background checks including, but not limited to, work references, driving records, criminal conviction
records and educational attainment.
You may be subjected to a criminal background investigation for some positions. If applicable, your fingerprints
may be sent to state and federal law enforcement agencies (DPS and FBI). All offers of employment and
continued employment may be subject to a complete review of any criminal convictions you may have. Your
failure to make a full and accurate disclosure of any prior conviction(s), or to answer the questions fully and
accurately, may result in immediate termination from employment or the rejection of any pending application or
offer from the State of Arizona.
CRIMINAL BACKGROUND INFORMATION (ALL APPLICANTS)
ALL QUESTIONS MUST BE ANSWERED TRUTHFULLY AND COMPLETELY. “Crime” as used in this section
means any and all felonies, misdemeanors and serious driving offenses, including but not limited to driving while
under the influence of intoxicating liquor (“DUI”) or drugs, extreme DUI, reckless driving, aggressive driving,
racing/exhibition of speed, excessive (criminal) speed, leaving the scene of an accident, driving on a suspended,
revoked or refused license or any other driving offense that is a misdemeanor (i.e., possible penalty for conviction
includes imprisonment or jail time). “Crime” does not include minor (civil) traffic offenses. If you are not sure how
to answer these questions, please ask a member of the Human Resources Department for assistance.
“Convicted” means you have been found guilty of a crime by a court or jury, or have pleaded guilty or
nolo contendere (“no contest”) to a crime and have been sentenced for a crime, whether imprisoned,
incarcerated, placed on probation, fined or received a suspended sentence.
**NOTE: A criminal conviction(s) may or may not constitute an automatic disqualification for employment.
Have you ever been convicted of any crime? Answer by writing “Yes” or “No” _________
If you have answered “yes” to this question, please give the details of offense(s) for which convicted, date(s) of conviction(s),
jurisdiction(s) (court, city, county, state, federal, foreign or military), and disposition(s) on the attached supplemental sheet
marked “Criminal Conviction History Form”. Exclude tickets for minor traffic and parking violations.
Name of Applicant ______________________
ASPS/HRD-FA3.01 10/12 2 of 7
Does the position you are applying for require you to drive a vehicle as part of your job responsibilities? If yes,
please see attached supplemental form marked “Driver Form”.
CONDITIONS OF CONSIDERATION FOR EMPLOYMENT
Can you provide verification of your eligibility to work in the U.S.? Yes No
Are you 18 years of age or older? Yes No
EDUCATION AND TRAINING
College, University, Trade or Business
Schools
City, State (List
campus attended)
Degree/Diploma
Attained/Year
Hours
Earned
Major Area of Study
Proof of your degree from an accredited College/University may be required upon hire.
Other Training: Name and Location of Institution
Topic of Training
Diploma/Certificate
List Current Licenses/Professional Registrations/Certifications
State Received
Expiration Date(s)
Do you currently or have you ever worked for the State of Arizona? Yes No
If yes, please state the name of the agency and the last employment date, if not included in the employment history below.
___________________________________________________________________________________
List reason for leaving State employment.
Have you ever been dismissed or allowed to resign in lieu of dismissal from a position for misconduct or
unsatisfactory service? Yes No
If yes, describe the circumstances even if you did not agree with your employer’s decision:
Name of Applicant ______________________
ASPS/HRD-FA3.01 10/12 3 of 7
EMPLOYMENT HISTORY
List all employers for the past ten (10) years beginning with the most recent first. Account for all time
employed, including self employment.
HOURS PER WEEK
DATES WORKED
From (Mo/Yr)
To (Mo/Yr)
EMPLOYER
SALARY
OTHER
Company Name:
Starting: Ending:
Per week, month, year
Position:
Address (No., Street, Suite No.)
Duties:
Supervisor’s Name:
City, State, Zip
Reason for Leaving:
Phone Number:
HOURS PER WEEK
DATES WORKED
From (Mo/Yr)
To (Mo/Yr)
EMPLOYER
SALARY
OTHER
Company Name:
Starting: Ending:
Per week, month, year
Position:
Address (No., Street, Suite No.)
Duties:
Supervisor’s Name:
City, State, Zip
Reason for Leaving:
Phone Number:
HOURS PER WEEK
DATES WORKED
From (Mo/Yr)
To (Mo/Yr)
EMPLOYER
SALARY
OTHER
Company Name:
Starting: Ending:
Per week, month, year
Position:
Address (No., Street, Suite No.)
Duties:
Supervisor’s Name:
City, State, Zip
Reason for Leaving:
Phone Number:
If presently employed, may we contact your employer? Yes No
If you need additional space, please use the last sheet of this application. _______________________________
Please list any other names you may have used while employed. _______________________________
Name of Applicant ______________________
ASPS/HRD-FA3.01 10/12 4 of 7
I certify that all the information provided herein is true and complete to the best of my knowledge. I agree
and understand that omissions, misstatements and falsifications may cause forfeiture on my part of all
eligibility to any employment with the State of Arizona and may be cause for rejection of this application,
removal of my name from eligibility lists, or dismissal from State employment. In addition, I give the
State of Arizona the right to investigate and verify any information obtained through the application
process. Permission is granted and I release from any and all liability any employer, agency, individual
or educational institution assisting the State of Arizona in providing relevant, job related information that
will assist in the process.
My signature below certifies that I have read and understand this application and agree to the
terms and conditions outlined in this document.
Applicant’s Signature Date
Printed Name
Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.
Persons with a disability may request a reasonable accommodation by contacting the Agency Human
Resources Office. Requests should be made as early as possible to allow time to arrange the
accommodation.
Name of Applicant ______________________
ASPS/HRD-FA3.01 10/12 5 of 7
CRIMINAL CONVICTION HISTORY
If you have ever been convicted of any crime, please give the details of the offense(s) for which
convicted, date(s) of conviction(s), jurisdiction(s) (court, city, county, state, federal, foreign or military),
and disposition(s). Please see page 1 for definition of “crimes”.
DATE
CONVICTION
MISDEMEANOR
OR FELONY
DISPOSITION
LAW
ENFORCEMENT
AGENCY
CITY
STATE
COUNTY
OTHER
FEDERAL,
FOREIGN,
MILITARY
Name of Applicant ______________________
ASPS/HRD-FA3.01 10/12 6 of 7
STATE OF ARIZONA
DRIVER FORM
I understand to operate a personally owned vehicle or fleet motor vehicle for the furtherance of State
business purposes, I must have an acceptable driving record and complete applicable driver training as
required by Arizona Administrative Code R2-10-207(12).
I understand the Driver Protection Privacy Act of 1994, amended September 1997, prohibits the release
of my Motor Vehicle Record for other than matters of motor vehicle or driver safety.
I understand I may be asked and would be responsible for providing a copy of my thirty-nine month
motor vehicle record history if I do not have a current Arizona driver license.
Name (print as it appears on your driver license)
Do you have a current valid U. S. driver license? Yes No
State Issuing and Driver License Number
Do you have a current valid U. S. commercial driver license? Yes No
State Issuing and Driver License Number
Signature Date
Name of Applicant ______________________
ASPS/HRD-FA3.01 10/12 7 of 7
PLEASE USE THIS PAGE FOR ANY ADDITIONAL INFORMATION
