[EMPLOYER] LOGO HERE APPLICATION FOR EMPLOYMENT Please provide complete and legible information. An incomplete application may affect your consideration for employment. If necessary, attach a separate sheet for additional information. [EMPLOYER NAME] is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin or ancestry, sex, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, marital status, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances. The information collected by this application is solely to determine suitability for employment, verify identity and maintain employment statistics on applicants. Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on [EMPLOYER NAME]. Please inform the company's personnel representative if you need assistance completing any forms or to otherwise participate in the application process. GENERAL INFORMATION Full Name Date FIRST MIDDLE LAST Address STREET CITY ZIP CODE Contact Number ( ) Date available for work Alternate Contact Number ( ) E-mail (optional) _______________________________________ Are you legally authorized to work in the ? Yes No Do you now, or will you in the future, require immigration sponsorship for work authorization (e.g., H-1B)? Yes No (If hired, verification will be required consistent with federal law.) Are you at least 18 years old? Yes No (If no, you may be required to provide authorization to work.) How were you referred to [EMPLOYER NAME]? POSITION INFORMATION Type of work desired? Salary expected (required) Applying for: Full-time Part-time Seasonal EDUCATION
Geographic Location From Month Year Your Position Supervisor's Name/Title To Month Year May we contact? Yes not, why? Primary responsibilities Reason for Leaving Employer Phone (___) Geographic Location From Month Year Your Position Supervisor's Name/Title To Month Year Primary responsibilities Reason for Leaving Employer (___) Geographic Location From Month Year Your Position Supervisor's Name/Title To Month Year Primary responsibilities Reason for Leaving Employer (___) Geographic Location From Month Year Your Position Supervisor's Name/Title To Month Year Primary responsibilities Reason for Leaving Have you worked for this company before? Yes No If yes, at what location? ____________ Job title: __________________ [Have you signed or otherwise agreed to any non-solicitation, non-competition or other similar agreement with any prior employer? Yes No If yes, explain: _______________________________________________________ ] Please account for any gaps of employment. ADDITIONAL COMMENTS Please comment on how your prior education and experiences qualify you for the type of employment you are seeking. Detail any past responsibilities and achievements. Note any special coursework, honors, activities, special projects or any other information that will assist us in considering your application for employment. PLEASE READ CAREFULLY AND INITIAL EACH PARAGRAPH BEFORE SIGNING