SAMPLE JOB APPLICATION

PLEASENOTE:Itisimportantthatyoucompleteallpartsoftheapplication.Ifyourapplicationisincompleteordoes notclearlyshowtheexperienceand/ortrainingrequired,yourapplicationmaynotbeaccepted.Ifyouhavenoinformation toenterinasection,pleasewriteN/A.

NameandAddress
Name(First,MI,Last) MailingAddress City,State,andZipCode Telephone Ifunder18,pleaselistage AlternatePhone Email SocialSecurityNumber

JobType
Days/hoursavailabletowork Ihaveno Mon. preference. Tues. Wed. Thurs. Fri. Sat. Sun.

Fulltimejob Iamseekinga: Howmanyhourscanyouworkweekly?

Parttimejob Canyouworknights?

FullorParttime Dateavailabletobegin

AdditionalInformation
Haveyoueverbeenemployedbythisorganizationinthepast? IcertifythatIamaU.S.citizen,permanentresident,oraforeignnationalwith authorizationtoworkintheUnitedStates. Haveyoueverbeenconvictedof,orenteredapleaofguilty,nocontest,orhada withheldjudgmenttoafelony? IfYes,pleaseexplain: Yes Yes Yes No No No

Doyouhaveadriverslicense? YesNo Haveyouhadanyaccidentsduringthepastthreeyears?

Driverslicensenumber

Issuedinwhatstate? Howmany? Howmany?

Haveyouhadanymovingviolationsduringthepastthreeyears?

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Education
School HighSchool Location(mailingaddress) Years Completed Major Degreeor Diploma

CollegeorBusiness/TradeSchool

Military
HaveyouevenbeenintheArmedForces? AreyounowamemberoftheNationalGuard? Specialty Yes Yes No No Dateentered Dischargedate

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WorkExperience
PleaselistALLworkexperiencebeginningwithyourmostrecentjobheld.Attachadditionalsheetsifnecessary.

Company Address City,State,andZipCode Phonenumber Reasonforleaving(bespecific)

Nameoflastsupervisor StartDate EndDate Yourlastjobtitle

Hrs/week StartingSalary FinalSalary

Listthejobsyouheld,dutiesperformed,skillsusedorlearned,advancementsorpromotionswhileyouworked atthiscompany.

Maywecontactthisemployer? YesNo Company Address City,State,andZipCode Phonenumber Reasonforleaving(bespecific) Listthejobsyouheld,dutiesperformed,skillsusedorlearned,advancementsorpromotionswhileyouworked atthiscompany. Nameoflastsupervisor StartDate EndDate Yourlastjobtitle Hrs/week StartingSalary FinalSalary

Maywecontactthisemployer? YesNo

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WorkExperience(continued)
Company Address City,State,andZipCode Phonenumber Reasonforleaving(bespecific) Listthejobsyouheld,dutiesperformed,skillsusedorlearned,advancementsorpromotionswhileyouworked atthiscompany. Nameoflastsupervisor StartDate EndDate Yourlastjobtitle Hrs/week StartingSalary FinalSalary

Maywecontactthisemployer? YesNo

References
Pleaseincludename,phonenumber,andcircumstancesofyouracquaintance.Excluderelativesandformeremployers.

1.

2.

3.

4.

Icertifythatallanswersandstatementsonthisapplicationaretrueandcompletetothebestofmy knowledge.Iunderstandthat,shouldthisapplicationcontainanyfalseormisleadinginformation,my applicationmayberejectedormyemploymentwiththiscompanyterminated. Signature Date

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