SAMPLE JOB APPLICATION FORM Many employers require all applicants, regardless of the job they apply for, to complete a job
application form. This way the employer will have consistent data on file for all prospective
applicants.
Instructions: Print clearly in black or blue ink. Answer all questions. Sign and date the form.
PERSONAL INFORMATION: First Name _____________________________
Middle Name ___________________________
Last Name _____________________________
Street Address
_______________________________________________________
City, State, Zip Code
_______________________________________________________
Phone Number
(___)___________________________________
Are you eligible to work in the United States?
Yes _______ No_______
If you are under age 18, do you have an employment/age certificate?
Yes ___ No ___
Have you been convicted of or pleaded no contest to a felony within the last five years?
Yes_______ No_______
If yes, please explain: _________________________________________
__________________________________________________________
POSITION/AVAILABILITY: Position Applied For
________________________________________
EDUCATION: Name and Address of School - Degree/Diploma - Graduation Date
_________________________________________________________________
_________________________________________________________________
Skills and Qualifications: Licenses, Skills, Training, Awards
_____________________________________________________________
_____________________________________________________________
EMPLOYMENT HISTORY: Present or Last Position:
Employer: _____________________________________________________
Address: ______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________
Email: ________________________________
Position Title: _________________________
From: ______________ To: ______________
Responsibilities: ____________________________________________________
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__________________________________________________________
Salary: _______________
Reason for Leaving: ____________________________________________