Employment Application
Applicant
Information
Full Name:
Date:
Last First
M.I.
Address:
Street Address Apartment/Unit #
City State ZIP Code
Phone:
(
)
E-mail
Address:
Date
Available:
Desired
Salary:
$
Position
Applied
for:
Referred
By:
YES NO
Are you authorized to work in the U.S
Do you have a current/valid WA driver’s lic.?
Have you ever worked for this company?
YES NO
YES NO
License No.
If
so,
when?
Education
High
School:
Address:
YES
NO
From:
To:
Did
you
graduate?
Degree:
College:
Address:
YES
NO
From:
To:
Did
you
graduate?
Degree:
Other:
Address:
YES
NO
From:
To:
Did
you
graduate?
Degree:
References Please list three professional
references.
Full
Name:
Relationship:
Years Known:
Company:
Phone:
(
)
Address:
Full
Name:
Relationship:
Years Known:
Company:
Phone:
(
)
Address:
Full
Name:
Relationship:
Years Known:
Company:
Phone:
(
)
Address:
Previous
Employment
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Disclaimer and
Signature
By signing my name below, I certify that the answers given in this application for employment are true and correct to
the best of my knowledge. I authorize such inquiry into the statements made in this application as may be necessary in
reaching an employment decision. I understand that any false or misleading information given in this application or
during a pre-employment interview, including failure to disclose requested information, may result in my discharge. I
understand that I may be required to pass a physical examination, including a drug test, before a final offer of
employment is made and that the employer may require random
testing after employment. By signing my name
below, I
consent to these procedures. Further, I understand and agree that any employment relationship with this employer is at
will” which means that the employee may resign or the employer may discharge the employee at any time, with or
without cause regardless of the date of payment of my wages and salary.
Please legibly PRINT your First and Last Name:
Signature Date:
click to sign
signature
click to edit
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