Form S-4 – Page 1 of 6 © The Personnel Advisor 609
APPLICATION FOR EMPLOYMENT
An EQUAL OPPORTUNITY EMPLOYER
(PLEASE PRINT)
Date of Application
Position(s) Applied For
Name
Telephone
Last First Middle Area Code
Address
Number Street City State Zip Code
If employed and under 18 years of age, can you furnish a work permit?
Yes No
Have you filed an application with this company before
Yes No
If yes, give date:
Have you ever been employed with this company before?
Yes No
If yes, give date:
Are you currently employed?
Yes No
If yes, may we contact your present employer? Yes No
Are you prevented from lawfully becoming employed
in this country because of visa or immigration status?
(
Proof of citizenship or immigration status will be required upon employment.)
Yes No
On what date would you be available for work?
When are you available to work?
Full Time Part Time Shift Work Temporary
Have you been convicted of a felony within the last 7 years?*
(
Conviction will not necessarily disqualify applicant from employment.)
Yes No
If yes, please explain:
(*California applicants: Do not disclose sealed, erased, or expunged convictions, or marijuana-related
convictions that are more than two years old.)
Form S-4 – Page 2 of 6 © The Personnel Advisor 609
APPLICATION FOR EMPLOYMENT
EDUCATION:
High School Vocational
Training
College/
University
Graduate/
Professional
School Name
Years Completed/
Degree
9 10 11 12 1 2 3 4 1 2 3 4 1 2 3 4
Diploma/Degree
Describe Course
of Study
Describe Specialized
Training,
Apprenticeship,
Skills and Extra-
Curricular Activities
Honors Received:
State any additional information you feel may be helpful to us in considering your application.
Form S-4 – Page 3 of 6 © The Personnel Advisor 609
APPLICATION FOR EMPLOYMENT
List professional, trade, business or civic activities and offices held. (You may exclude memberships that
would reveal sex, race, religion, national origin, age, ancestry, disability or other protected status.)
Give name, address and telephone numbers of three references who are not related to you and are not
previous employers.
1. Name: Telephone:
Address:
2. Name: Telephone:
Address:
3. Name: Telephone:
Address:
EMPLOYMENT EXPERIENCE
Start with your present or last job. Include military service assignments and volunteer activities. (You
may exclude organization names that would reveal sex, race, religion, national origin, age, ancestry,
disability or other protected status.)
1.
Employer:
Dates Employed
Address:
From:
To:
Phone Number:
Hourly Rate/Salary
Job Title:
Supervisor:
Starting:
Final:
Work Performed:
Reason for Leaving:
Form S-4 – Page 4 of 6 © The Personnel Advisor 609
2.
Employer:
Dates Employed
Address:
From:
To:
Phone Number:
Hourly Rate/Salary
Job Title:
Supervisor:
Starting:
Final:
Work Performed:
Reason for Leaving:
3.
Employer:
Dates Employed
Address:
From:
To:
Phone Number:
Hourly Rate/Salary
Job Title:
Supervisor:
Starting:
Final:
Work Performed:
Reason for Leaving:
4.
Employer:
Dates Employed
Address:
From:
To:
Phone Number:
Hourly Rate/Salary
Job Title:
Supervisor:
Starting:
Final:
Work Performed:
Reason for Leaving:
If you need additional space, please continue on a separate sheet of paper.
Form S-4 – Page 5 of 6 © The Personnel Advisor 609
APPLICATION FOR EMPLOYMENT
Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment experience or education.
NOTES:
Form S-4 – Page 6 of 6 © The Personnel Advisor 609
APPLICATION FOR EMPLOYMENT
Applicant’s Statement
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be
necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 180 days. If I
wish to be considered for employment beyond this time period, I understand that I need to inquire as to
whether or not applications are being accepted at that time.
I understand that neither this document nor any offer of employment from the employer constitutes an
employment contract unless a specific document to that effect is executed by the employer and me in
writing.
In the event of employment, I understand that false or misleading information given in my application or
interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and
regulations of the employer.
Signature of Applicant Date
click to sign
signature
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