(614) 257-8123

Application for Employment

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

DATE:

Name (Last, First, Middle, Maiden):

Present address: City: State: Zip:

How long? Telephone: Email:
Position applying for:
Days/hours available to work
No preference		Thursday	Hours
Monday	Hours	Friday	Hours
Tuesday	Hours	Saturday	Hours
Wednesday	Hours	Sunday	Hours

How many hours can you work weekly? Can you work nights?

Employment desired:	FULL-TIME ONLY	PART-TIME ONLY	FULL OR PART-TIME
When available for work?

TYPE OF SCHOOL	NAME OF SCHOOL	LOCATION (Complete mailing address)	NUMBER OF YEARS COMPLETED	MAJOR & DEGREE
High School:
College:
Bus. or trade School:
Professional School:

HAVE YOU EVER BEEN CONVICTED OF A CRIME? No Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

DO YOU HAVE A DRIVER'S LICENSE? Yes No

What is your means of transportation to work?

Driver's license number: State of issue: Expiration date:

Have you had any accidents during the past three years? Yes No | How many?

Have you had any moving violations during the past three years? Yes No | How many?

OFFICE ONLY

Typing: Yes No WPM	10-key: Yes No	Word processing: Yes No WPM
Personal computer experience: Yes No Other skills:

Please list two references other than relatives or previous employers.

Name:

Position:

Company:

Address:

Telephone:

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES? Yes No
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD? Yes No
Specialty: Date Entered: Discharge Date:

Work Experience

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
Name of employer:		Name of last supervisor:
Address (City, State, Zip Code): City: State: Zip:
Phone:
Your last job title:
Employment dates:		Pay or salary:
From:		Start:
To:		Final:

Reason for leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Work Experience 2

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
Name of employer:		Name of last supervisor:
Address (City, State, Zip Code): City: State: Zip:
Phone:
Your last job title:
Employment dates:		Pay or salary:
From:		Start:
To:		Final:

Reason for leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Work Experience 3

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
Name of employer:		Name of last supervisor:
Address (City, State, Zip Code): City: State: Zip:
Phone:
Your last job title:
Employment dates:		Pay or salary:
From:		Start:
To:		Final:

Reason for leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact your present employer? Yes No

Did you complete this application yourself? Yes No

If not, who did?