EMPLOYMENT APPLICATION
Date ________________________________ Position Applied For _________________________________
Personal Information
Full Name ____________________________________________________________________________________
Last First Middle
Address ______________________________________________________________________________________
Street City Zip
Telephone number_____________________________ Email Address ______________________________
Are you legally eligible for employment in the United States? Yes _______________ No _____________
Have you ever been convicted of a felony crime? Yes _______________ No ____________
If yes, please explain ___________________________________________________________________________
Have you ever been convicted of a misdemeanor crime? Yes ______________ No _____________
If yes, please explain ___________________________________________________________________________
Are there felony charges pending against you? Yes ______________ No ______________
If yes, please explain ____________________________________________________________________________
Previous Employment (As you complete this section, refer to your current or most recent employer first.)
_____________________________________________________________________________________________
Employer 1
_____________________________________________________________________________________________
Street Address City/State Phone Number
________________________ _________________________ ___________________
Job Title Employment Dates Pay (specify per wk/yrly)
_____________________________________________________________________________________________
Describe Your Work Duties
________________________ _________________________
Supervisor’s Name Reason for Leaving
Previous Employment (Continued)
_____________________________________________________________________________________________
Employer 2
_____________________________________________________________________________________________
Street Address City/State Phone Number
________________________ _________________________ ___________________
Job Title Employment Dates Pay (specify per wk/yrly)
_____________________________________________________________________________________________
Describe Your Work Duties
________________________ _________________________
Supervisor’s Name Reason for Leaving
_____________________________________________________________________________________________
Employer 3
_____________________________________________________________________________________________
Street Address City/State Phone Number
________________________ _________________________ ___________________
Job Title Employment Dates Pay (specify per wk/yrly)
_____________________________________________________________________________________________
Describe Your Work Duties
________________________ _________________________
Supervisor’s Name Reason for Leaving
_____________________________________________________________________________________________
Employer 4
_____________________________________________________________________________________________
Street Address City/State Phone Number
________________________ _________________________ ___________________
Job Title Employment Dates Pay (specify per wk/yrly)
_____________________________________________________________________________________________
Describe Your Work Duties
________________________ _________________________
Supervisor’s Name Reason for Leaving
Education
School Name__________________________________________________________________________________
Address ______________________________________________________________________________________
Years Completed _______________________________________________________________________________
Did you Graduate? ______________________________________________________________________________
Degree/Diploma _______________________________________________________________________________
School Name__________________________________________________________________________________
Address ______________________________________________________________________________________
Years Completed _______________________________________________________________________________
Did you Graduate? ______________________________________________________________________________
Degree/Diploma _______________________________________________________________________________
School Name__________________________________________________________________________________
Address ______________________________________________________________________________________
Years Completed _______________________________________________________________________________
Did you Graduate? ______________________________________________________________________________
Degree/Diploma _______________________________________________________________________________
Professional licenses, certifications, and/or training relevant to the position desired:
References (business and professional only)
Name ________________________________________________________________________________________
Address ______________________________________________________________________________________
Phone _______________________________________________________________________________________
Relationship __________________________________________________________________________________
Name ________________________________________________________________________________________
Address ______________________________________________________________________________________
Phone _______________________________________________________________________________________
Relationship __________________________________________________________________________________
Name ________________________________________________________________________________________
Address ______________________________________________________________________________________
Phone _______________________________________________________________________________________
Relationship __________________________________________________________________________________
Applicant’s Certification
I certify that all statements in this application are true and correct to the best of my knowledge. I understand that
false or misleading information contained in this application, and/or provided verbally will be cause for my
application to be rejected, or if discovered after employment, will be cause for immediate discharge.
____________________________
Date
___
_________________________________________________
_ Applicant’s Signature (Please type your First and Last Name)
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signature
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Applicant’s Consent to Contact References
As an applicant for a position with Alma College, I have been requested to furnish information
for use in determining my qualifications. To that end, I hereby authorize the release and full
disclosure of any information that any of my current and former employers may have concerning
my employment with their organization. I authorize any/all of my current and former employers
to release such employment information to those employees and agents of Alma College who
require such information in order to make a decision with respect to any matter pertaining to my
status as an employee. This information may be provided either verbally or in writing.
In addition to authorizing the disclosure and release of any information regarding my
employment, I hereby fully waive any rights or claims I have or may have against any previous
employer, its agents, employees, and representatives for providing such information, and fully
release them from any and all liability, claims, or damages that may directly or indirectly result
from the use, disclosure or release of any such employment information, whether such
information is favorable or unfavorable to me.
Further, I am hereby authorizing Alma College to communicate with anyone that they may wish
to talk with about my experiences, skills, and qualifications in the context of the position I am
currently seeking at the College. I understand the College may contact individuals beyond my
list of references.
I acknowledge that I have read this authorization and release, fully understand it, and voluntarily
agree to its provisions. This release will expire one (1) year after the date signed.
________________________
Date
______________________________________
Signature (Please type your name)
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