Fillable Printable Employment Application - Alaska

Employment Application - Alaska

Rev. 8/20 10 Emp loyme nt Application Page 1 of 2

COMPANY OR EMPLOYER NAME:

Position applying for:

EMPLOYEE INFORMATION

Name:

Last First Middle

Telephone:

Email:

Alternate telephone:

Address:

Are you able to perform the essential functions of If necessary for the job, I am able to:

the posit i on with or without accommoda tio ns?

Work overtime?

Yes No

Provide a valid Alaska Driver's License?

Yes No

If necessary for t he job are you older than

If so, fill out the followin g:

Issuing state:

14 15 16 (Check one)

Type:

18 19 21

Endorsement(s):

Hazardous Material Passengers

I am legally eligible for employment in the U.S.?

Tankers Tank with Hazardous Materials

Yes No

School Bus Double/Triple trailers

I am seeking a permanent position:

Yes No

Work the following s hifts: (check all that apply)

I will be able to report to work

Any Day Night Swing Rotating

days after being notified I am hired.

Split Graveyard Other:

EMPLOYMENT HISTORY

List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed

here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.

Employer name and address: Position title/ d uties, skills:

Start date:

End date:

Reason for leaving:

Pay:

Per: Supervisor: Telephone:

Employer name and address: Position title/ d uties, skills:

Start date:

End date:

Reason for leaving:

Pay: $

Per:

Supervisor:

Telephone:

Employer name and address:

Position title/ d uties, skills:

Start date:

End date:

Reason for leaving:

Pay: $

Per: Supervisor: Telephone:

Employer name and address:

Position title/ d uties, skills:

Start date:

End date:

Reason for leaving:

Pay:

Per: Supervisor: Telephone:

Employment

Application

Rev. 8/20 10 Emp loyme nt Application Page 2 of 2

Developed at employe r request by the Alas ka Department of Labor & Workforce Development, Employment Security Division.

Summarize other employment related to this job:

EDUCATION

Institution name

Years

completed

Field of st udy Graduate or degree

High school

College/university

Business/technical

Additional

MILITARY

Are you a veteran? Yes No

Duty/spe cialized training:

SKILLS & QUALIFI CAT IONS

Other qualifications such as special skills, abilities or ho nor s that should b e considered:

Types of computers, software, and other equipment you are qualified to operate or repair:

Professio na l licenses, certifi cations or registrations:

Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish t o bring

to the employer’s attention:

Typing speed:

per minute

REFERENCES

List two personal references who are not relatives or former supervisors.

Name Address Telephone Occupation Years known

Name

Address

Telephone

Occupation

Years known

CONTACT

In case of accident or illness, please contact: Name:

Dayt ime phone:

Address: Relationship:

INFORMATION TO THE APPLICANT

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you

have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may

make a written request for information derived from the checking of your references.

If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United

States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and

ag ree t o the informa tion shown a b ove.

Signature of Applicant Date

Equal Employment Oppo rtunity:

While many employers are required by federal law to have an Affirmative Action Program, a ll employers are required to

provide equal em ployment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional

and failure to provide it w ill have no affec t on your ap plication for e m ployment.