Acme Widgets
Employment Application
APPLICANT INFORMATION
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Last Name
First
M.I.
Date
Street Address
Apartment/Unit #
City
State
ZIP
Phone with Area Code
E-mail
Date Available
Social Security Number
Desired Salary $
Hourly
Weekly
Monthly
Annually
Position Applied for
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
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High School
Address
From
To
Did you graduate?
Yes
No
Degree
College
Address
From
To
Did you graduate?
Yes
No
Degree
Other
Address
From
To
Did you graduate?
Yes
No
Degree
REFERENCES
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Please list three professional references.
Full Name
Relationship
Company
Phone
(
)
Address
Full Name
Relationship
Company
Phone
(
)
Address
Full Name
Relationship
Company
Phone
(
)
Address
PREVIOUS EMPLOYMENT
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Company
Phone
(
)
Address
Supervisor
Job Title
Starting Salary $
Hourly
Weekly
Monthly
Annually
Ending Salary $
Hourly
Weekly
Monthly
Annually
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Company
Phone
(
)
Address
Supervisor
Job Title
Starting Salary $
Hourly
Weekly
Monthly
Annually
Ending Salary $
Hourly
Weekly
Monthly
Annually
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Company
Phone
(
)
Address
Supervisor
Job Title
Starting Salary $
Hourly
Weekly
Monthly
Annually
Ending Salary $
Hourly
Weekly
Monthly
Annually
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
MILITARY SERVICE
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Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable, explain
DISCLAIMER AND SIGNATURE
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I certify that my answers are 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. You will be asked to sign a printed copy of this application during your interview.
Signature
Date
Include a copy of this application as an email attachment