Employment Application

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

EMPLOYMENT APPLICATION
An Equal Opportunity Employer

The ___________ Corporation is an Equal Opportunity Employer and does not discriminate on the 
basis of race, color, creed, religion, sex, age, marital status, national origin, disability 
or other classification protected by applicable law.


NAME: __________________________________________________________________________________
		Last 			First					Middle

ADDRESS: _______________________________________________________________________________
		Number/Street		City		State		Zip Code

SOCIAL SECURITY NUMBER: __________-__________-__________

TELEPHONE NUMBER WITH AREA CODE:  Day (____) _____________  Evening (____)_______________

POSITION APPLIED FOR: _______________________________     Full time ____   Part time ____ 	 
	Salary Expected: $__________________________	 Date Available:_______________

Have you worked for The _______________ Corporation before?	 Yes_____	  No_____

	If yes, list dates, department, and titles: ______________________________________

	If previously employed, why did you leave? _______________________________________

Have you applied for employment with The ___________ Corporation before?  

	 Yes_____  (Date ________________)	  No_____  

Are you legally eligible to work in the United States?   Yes ____   No ____

EDUCATION:  (Only job-related education will be considered)
	Name and	Circle	        Did	        Major Course
	Location	Last Year	You	        Degree
	of  School	Completed	Graduate?	Received

 
High School	_________________________     1 2 3 4

		_________________________

College		_________________________     1 2 3 4

		_________________________

Other		_________________________     1 2 3 4


LIST ANY SPECIAL EXPERIENCES, QUALIFICATIONS OR SKILLS YOU HAVE THAT YOU BELIEVE WOULD 
HELP YOU DO THE JOB APPLIED FOR:


LIST ANY SPECIAL LICENSES OR CERTIFICATIONS YOU HAVE THAT YOU BELIEVE WOULD HELP YOU 
DO THE JOB APPLIED FOR:  (List Licensing Authority, License Number, and Date of License 
for each)


	Do you have a valid driver's license?	Yes 		No 
	If yes, what state and number:	State 		Number _____________

LIST ANY EXPERIENCE YOU HAVE IN OPERATING COMPUTERS  OR OTHER BUSINESS EQUIPMENT THAT 
YOU BELIEVE WOULD BE USEFUL IN THE JOB APPLIED FOR:


IF REQUIRED FOR THE JOB YOU ARE SEEKING, 
		DO YOU TYPE? ______ TAKE SHORTHAND? ______
	
	Approximate speed:  TYPING _____  wpm    SHORTHAND _____ wpm

PRIOR EMPLOYMENT:  (Give the following information for all present and previous employers, 
beginning with the most recent.)

Employer Name,                                            Were you Disciplined?
Address, and                                              (Warning, Suspension,
Phone Number   Dates of Employment  Job Title	Pay Rate  or Discharge)  Reason for Leaving
                                                          	
                                                           Yes    No ______________________		
                                                           Yes    No ______________________ 		
                                                           Yes    No ______________________ 		
                                                           Yes    No ______________________ 		

Have you had disciplinary problems with any previous employer? 

	Yes _____	  No _____	

	If yes, please name the employer and describe the circumstances:




PLEASE LIST THREE INDIVIDUAL REFERENCES FROM PEOPLE WHO ARE FAMILIAR WITH YOUR WORK, 
SKILLS, ABILITY AND CHARACTER:

Name	Address	Phone	How long known?	What capacity?
				
_______________	_______________	_______________	_______________	_______________
_______________	_______________	_______________	_______________	_______________
_______________	_______________	_______________	_______________	_______________


HAVE YOU EVER BEEN CONVICTED OF A CRIME OR RECEIVED A VERDICT OF ANYTHING OTHER THAN 
NOT GUILTY IN ANY CRIMINAL INVESTIGATION OR PROCEEDING?
	Yes _____	  No _____	
	If yes, describe when the conviction occurred, the facts and circumstances, 
and any facts pertaining to rehabilitation.  (Do not list any criminal charges for 
which the records have been expunged.  A criminal offense will not necessarily bar 
employment.):

UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF 
EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL 
SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST.  AN EMPLOYER WHO VIOLATES THIS 
LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

______________________			_________________________________	
Date						Signature of Applicant


INFORMATION FOR APPLICANT
(Please Read Carefully Before Signing)

	This application is valid for only thirty (30) days.  If you have not been 
employed within thirty (30) days of your application, you must re-apply for a position.

By my signature below, I agree to the following:

	a.	I consent to take any physical examinations, including but not limited 
                to tests for alcohol or drugs, that may be requested by The _________ 
                Corporation (1) following an offer of employment and prior to 
                commencement of work; and (2) during the course of my employment, 
                consistent with applicable law, including but not limited to the 
                Americans With Disabilities Act.  I further authorize any health care 
                professional who performs such an examination or who has other 
                information concerning my physical, mental or other medical status to 
                release such information to The _________ Corporation.

	b.	I understand that any false statements or misleading omissions made by 
                me in connection with my application, or in responding to requests for 
                information, will be sufficient grounds for my rejection as a candidate 
                for employment or for my immediate discharge.

	c.	I understand that any employment I might be offered by The _________ 
                Corporation is at- will and of indefinite duration, and that either I or 
                The _________ Corporation can terminate that employment at any time with 
                or without notice for any or no reason, and that no agreement to the 
                contrary will be recognized by The _________ Corporation unless made in 
                writing and signed by the President of The _________ Corporation.  I 
                understand that satisfactory completion of my provisional period will not 
                change my status as an at-will employee.

	d.	I understand that none of The _________ Corporation's practices or 
                policies are to be construed as imposing any binding obligations on the 
                Company, and that they are subject to change or deletion at any time.

	e.	I hereby authorize The _________ Corporation to obtain from schools, 
                former employers, or other individuals or institutions it contacts, any 
                information in their possession regarding my employment history or 
                qualifications for the job for which I have applied.

	I understand and agree that The __________ Corporation may engage an outside 
        investigator to conduct an investigation of my conduct if I am accused of 
        wrongdoing in my employment with The _________ Corporation.

I have read this Employment Application and I understand its contents.

___________________				___________________________________	
Date								Signature of Applicant

REFERENCE RELEASE FORM


I authorize The _________ Corporation to seek from all my previous and present schools 
and employers, and authorize all my previous and present schools and employers to release 
to The _________ Corporation, any and all information pertaining to my educational and 
employment history.

If I am offered employment, I also authorize the disclosure to The _________ Corporation 
of any medical history that may be necessary to verify information provided as a part of 
the application process.

I release, promise to hold harmless, and covenant not to sue The _________ Corporation 
on the basis of its attempts to obtain information from my previous and present schools 
and employers.  I release, promise to hold harmless, and covenant not to sue my previous 
and present schools, employers, or health care providers on the basis of the disclosure 
of information to The _________ Corporation.


__________________	________________________________										
Date			Name of Applicant

			______________________________________	
			Signature of Applicant
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You may copy, modify and use this sample without restriction.
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THE ______________ CORPORATION

EMPLOYMENT APPLICATION An Equal Opportunity Employer

EMPLOYMENT APPLICATION
An Equal Opportunity Employer
