Discussion

1

North Florida Widgets, Inc.

Employment Application

Applicant Information

Full Name: Date:

Last First M.I.

Address:

Street Address Apartment/Unit #

City State ZIP Code

Phone: Email

Alternate Phone: Date Available: Desired Salary: $

Position applied for:

Are you a citizen of the United States? YES

NO

Do you have a valid U.S. driver’s license? YES

NO

Have you ever worked for this company? YES

NO

If yes, when?

Have you ever been convicted of a felony? YES

NO

Due to the hazardous nature of our work, applicants must be at least 18 years old. What is your date of birth?

Education

High School: Address:

From: ______ To:_______ Did you graduate? YES

NO Year of graduation: __________

College: Address:

From: To: Did you graduate? YES

NO

Degree:

Other: Address: _______________________________________________

From: To: Did you graduate? YES

NO

Degree:

References

Please list three professional references.

Full Name: Relationship:

Company: Phone:

Address:

2

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

Previous Employment

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: $ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

On average, how many sick days did you use per month? May we contact your previous supervisor for a reference?

YES

NO

Emergency Contact

In case of emergency, who should be notified? Phone: Other:

Please indicate if you are single, married, separated, or divorced: Number of dependents:

Do you have any disabilities? If so, explain:

Disclaimer and Signature

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.

Signature: Date: