Application For Employment

You may copy, modify and use this sample without restriction.

Download PDF file

1. Name: ______________________________________________________

2. Address: ___________________________________________________

3. Telephone Number: (Home) ____________ (Work) ________________________________

4. Social Security Number: _____________ 5. Driver's License #: ___________________

6. How did you learn about our organization? ________________________________________

7. Are you eligible to work in the United States? _____ Yes _____ No

8. Work Desired.

a. Position(s) for which you are applying: ________________________________________

b. Salary Requirements: _____________________________________

c. Shift ____________________________________________________

d. Date available for work: _________________________________

9. Qualifications. Describe your skills and qualifications: ________________________

__________________________________________

10. Education. List any schools, colleges or universities you have attended below:

No. of Years____ Did You Graduate?____ Certificate, Degree or _______________

Name of School Attended Yes/No Course Diploma Earned

__________________________________________

11. Have you ever been convicted of a crime (such conviction may be relevant if job related,

but may not necessarily bar you from employment.) ___ Yes ___ No

If yes, please explain: __________________________________________________________

12. Are there any reasons why you would not be able to perform the duties of any position

for which you are applying? _____ Yes _____ No

If yes, please describe: _________________________________________________________

13. Employment History. List your last three employers below, starting with your current
employer.

_________________________________________________________________________________

Employer name, address and telephone number Employed From/To Salary Start/End

___________________________________________

Supervisor's Name: _________________ Job Title: ________________

Describe your duties: ___________________________________________

Reason for leaving: _____________________________________________

_________________________________________________________________________________

Employer name, address and telephone number Employed From/To Salary Start/End

___________________________________________

Supervisor's Name: _________________ Job Title: ________________

Describe your duties: ___________________________________________

Reason for leaving: _____________________________________________

_________________________________________________________________________________

Employer name, address and telephone number Employed From/To Salary Start/End

___________________________________________

Supervisor's Name: _________________ Job Title: ________________

Describe your duties: ___________________________________________

Reason for leaving: _____________________________________________

_________________________________________________________________________________

14. Set forth any additional information in support of your application you wish to bring

to our attention:

___________________________________________

I verify that the information contained in this Application for Employment is true, and
I authorize the Company to seek references from my current and former employers, as
indicated by my signature on the attached authorization. I agree to submit to a physical
examination and drug screening as required by the Company. I further agree that, if
hired, either the Company or I may terminate our relationship at will, with or without
notice, and for any reason. Moreover, I understand that only the President of the
Company may enter into any agreement concerning the length of my employment.

The Company is an equal opportunity employer. This application for employment will be
current for only sixty days. A new application must be completed if the applicant
wishes to be considered for employment after that time.

____________________________ _______________________________
Signature Date

UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT
OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR
OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT.
ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A
FINE NOT TO EXCEED $100.

_______________________________
Signature

Back to forms page

You may copy, modify and use this sample without restriction.

Kollman & Saucier, P.A., The Business Law Building, 1823 York Road, Timonium, MD 21093 Phone: 410-727-4300
Fax: 410-727-4391 © 1999 - 2012 Kollman & Saucier, P.A. All rights reserved.
Website maintained by Armistead Technologies, Llc.