Fillable Printable Basic Application Form for Employment

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.