Master Job Application Form
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The information contained on this form is CONFIDENTIAL according to
MASTER JOB APPLICATION
470 IAC 1-2-7, 470 IAC 1-3-1, and 470 6-1-1.
State Form 48245 (R4 / 6-12) / IMP 0021
PERSONAL INFORMATION
Are you a U.S. citizen?
If No, are you legally allowed to work in the U.S.?
Registration number
Yes
No
Yes
No
Date (month, day, year)
Social Security number (Please enter last four (4) digits only)
XXX-XX- ______
Name (last, first, middle)
Present address (number and street, city, state, and ZIP code)
Permanent address (number and street, city, state, and ZIP code)
Primary telephone number
Alternate telephone number
(
)
(
)
Have you ever been convicted of a felony?
If Yes, explain in full. (Attach additional sheet, if necessary.)
Yes
No
If Yes, what type?
Do you have a valid driver's license?
Yes
No
Operator
Commercial
Chauffeur
EMPLOYMENT DESIRED
Salary desired
Position for which you are applying
Date you can start (month, day, year)
Are you currently employed?
If so, may we contact your present employer?
Have you ever applied to this company before?
Where?
When?
Work preference
Full-time
Part-time
No preference
EDUCATION
SUBJECTS STUDIED AND
DID YOU
CHECK LAST
CERTIFICATE, DIPLOMA, DEGREE
TYPE OF SCHOOL
NAME AND LOCATION OF SCHOOL
GRADUATE?
YEAR COMPLETED
RECEIVED
Yes
1
2
3
4
ELEMENTARY/
No
MIDDLE SCHOOL
5
6
7
8
Yes
HIGH SCHOOL
9
10
11
12
No
Yes
COLLEGE
1
2
3
4
No
TRADE, BUSINESS OR
Yes
1
2
3
4
CORRESPONDENCE SCHOOL
No
Describe any special studies, skills, and experiences, or foreign language abilities that could enhance your job performance.
PHYSICAL RECORD (Do you have any physical condition which may limit your ability to perform the job for which you are applying?)
This question is voluntary, and any answers will be kept confidential.
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Parent category: Business