Simple Job Application Form

Full Name

First Name Middle Name Last Name

Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Email Address

example@example.com

Position(s) Applied for:

The best time (or time window) to call you is:

May we contact you at work?

Yes No

How did you hear about us?

Have you ever been employed here before?

Yes No

Are you lawfully authorized to work in the United States?

Yes No

Have you entered into an agreement with any former employer or other party (such as noncompetition agreement) that might, in any way, restrict your ability to work for our company?

Yes No

Available Start Date

Date

What is your desired salary range or rate of pay?

Type of employment desired

Full Time Part Time Seasonal Educational Co-op Temporary

Will you travel if job requires it?

Yes No

If they have been explained to you, are you able to meet the attendance requirements of the position?

Yes No

Will you work overtime if required?

Yes No

If no, please explain:

Are you able to perform the “essential functions” of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Yes No Need more information about the job’s “essential functions" to respond.

Have you ever pleaded “guilty” or “no contest” to or been convicted of a crime? NOTE: Answering “yes” to this question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. You are not obligated to disclose convictions that have been expunged.

Yes No

Skills and Qualifications: Summarize any special training, skills, languages, licenses, bonding, certifications, and/or certificates that may assist you in performing the position for which you are applying:

Upload Your Resume

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Cover Letter