H&R Block Employment Application

Full Name

First NameLast Name

Address

Phone Number

E-mail

example@example.com

DOB

Date

SSN

Please select if you are fluent in the following languages:

EnglishSpanish

What position are you applying for?*

Available start date:

Date

What days are you available to work?

On days available, what hours are you available?

Authorization for a background check

Consent for employer to conduct background check

Signature