Employment Application Form printable pdf download

Name______________________________________________________________ Date_____________________

Address_____________________________________ City___________________ State________ Zip__________

Home Phone_______________ Cell Phone______________Email Address: ______________________________

On what date would you be available for work? ____________________ Desired Wage/Salary $_____________

Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? [ ] Yes [ ] No

Have you ever been convicted of a felony? [

] Yes [

] No

If yes, please describe circumstances: __________

_________________________________________________________________________________________

Have you ever been involuntarily terminated or asked to resign from any position of employment? [ ] Yes [ ] No

If yes, please describe circumstances: _________________________________________________________

_________________________________________________________________________________________

If selected for employment, are you willing to submit to a pre-employment drug screening test?

[ ] Yes [ ] No

Highest Grade Completed

Post-Secondary

Other

Grade Point Average

11 12

EMPLOYMENT

(Most Recent First.)

1. Employer__________________________________ Job Title______________Phone____________________

Supervisor_______________________Ending Salary_________Dates Employed_________________________

Reason for Leaving ___________________________________________________________________________

2. . Employer__________________________________ Job Title______________Phone____________________

Supervisor_______________________Ending Salary_________Dates Employed_________________________

Reason for Leaving ___________________________________________________________________________

3. . Employer__________________________________ Job Title______________Phone____________________

Supervisor_______________________Ending Salary_________Dates Employed_________________________

Reason for Leaving ___________________________________________________________________________

ACKNOWLEDGMENT AND AUTHORIZATION

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in

arriving at an employment decision.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship

with this organization is of an “at will” nature, which means that the Employee may resign at any time and the

Employer may discharge Employee at any time with or without cause. It is further understood that this “at will”

employment relationship may not be changed by any written document or by conduct unless such change is

specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application

or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of

the employer.

Signature of Applicant: __________________________________________________Date___________________-

Employment Application Form