Sample Employment Application

APPLICANT INFORMATION
Last Name First Name         M.I.  
Street Address Apartment/Unit #   
City State          Zip  
Phone Email
Social Security No. Date Available
Position Applied For Desired Salary
Are you a citizen of the United States? Yes    No
If no, are you authorized to work in the U.S.? Yes    No
Have you ever worked for this company? Yes    No
If so, when?
Have you ever been convicted of a felony? Yes    No
If yes, explain
EDUCATION
High School
Address
Dates attended: From      To
Did you graduate? Yes    No
Degree
College
Address
Dates attended: From      To
Did you graduate? Yes    No
Degree
Other
Address
Dates attended: From      To
Did you graduate? Yes    No
Degree, certificate, or credential
PREVIOUS EMPLOYMENT
Company
Address
Phone
Job Title
Responsibilities
Starting Salary Ending Salary
Starting Date Ending Date
Reason for Leaving
Supervisor
May we contact this supervisor for a reference? Yes    No
Company
Address
Phone
Job Title
Responsibilities
Starting Salary Ending Salary
Starting Date Ending Date
Reason for Leaving
Supervisor
May we contact this supervisor for a reference? Yes    No
Company
Address
Phone
Job Title
Responsibilities
Starting Salary Ending Salary
Starting Date Ending Date
Reason for Leaving
Supervisor
May we contact this supervisor for a reference? Yes    No
MILITARY SERVICE
Branch Dates Served: From       To  
Rank at Dischange Type of Discharge
If other than honorable, explain
REFERENCES (please list three)
Full Name
Relationship
Company
Email Address
Phone
Full Name
Relationship
Company
Email Address
Phone
Full Name
Relationship
Company
Email Address
Phone
DISCLAIMER
By clicking "Submit My Application," I certify that my answers are accurate, true, and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.