EMPLOYMENT / JOB APPLICATION

 

PERSONAL INFORMATION

 

FULL NAME:  _______________________________________________________ DATE: ____________________ First Middle Last

ADDRESS: ___________________________________________________________________________________ Street Address Apt/Suite ____________________________________________________________________________________ City State Zip Code E-MAIL: ___________________________________________________ PHONE: ___________________________ SOCIAL SECURITY NUMBER (SSN): __________-__________-__________ DATE OF BIRTH: _______________ DATE AVAILABLE: ____________________________ DESIRED PAY: $________________ ☐ HOUR ☐ SALARY POSITION APPLIED FOR: ______________________________________________________________________ EMPLOYMENT ELIGIBILITY ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO*

HAVE YOU EVER WORKED FOR THIS EMPLOYER? ☐ YES* ☐ NO

*IF YES, WRITE THE START AND END DATES: ____________________________________________________

HAVE YOU EVER BEEN CONVICTED OF A FELONY? ☐ YES* ☐ NO

*IF YES, PLEASE EXPLAIN: ____________________________________________________________________

 

BACKGROUND CHECK CONSENT

 

IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? ☐ YES ☐ NO EDUCATION HIGH SCHOOL: _______________________________________ CITY / STATE: ___________________________ FROM: _____________________ TO: _____________________ GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________ COLLEGE: _____________________ ------------------------------------ CITY / STATE: ___________________________ FROM: _____________________ TO: _____________________ GRADUATE? ☐ YES ☐ NO DEGREE: ____________________