APPLICATION FOR EMPLOYMENT
This generic application is provided by WorkSource Washington. This form complies with federal and state laws against discrimination; however, employers using this form should check local ordinances. WorkSource Washington and Washington State Employment Security are not responsible for the misuse of information provided on this form. Provide all information requested by printing in ink or typing. Use the 'TAB' key to move through the document.
GENERAL INFORMATION
Name (Last) Address (Mailing Address) E-Mail Address (First) (City) (State) (Middle Initial) (Zip) Home Telephone
( (
Are you legally entitled to work in the U.S.? Will Accept: Part-Time Full-Time Temporary
Date Available
) ) Yes
No
Other Telephone
POSITION
Position Or Type Of Employment Desired
Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodation? Yes No
Salary Desired
Shift: Day Swing Graveyard Rotating
EDUCATION AND TRAINING
High School Graduate Or General Education (GED) Test Passed? If no, list the highest grade completed
Yes
No
College, Business School, Military (Most recent first)
Name and Location Dates Attended Month/Year Credits Earned Quarterly or Other Semester (Specify) Hours Graduate Degree & Year Major or Subject
From To From To From To From To
Occupational License, Certificate or Registration Number
Yes No Yes No Yes No Yes No
Where Issued Expiration Date
Occupational License, Certificate or Registration Occupational License, Certificate or Registration
Number Number
Where Issued Where Issued
Expiration Date Expiration Date
Languages Read, Written or Spoken Fluently Other Than English
VETERAN INFORMATION (Most recent)
Branch of Service Date of Entry Date of Discharge
SPECIAL SKILLS (List all pertinent skills and equipment that you can operate)
(Maximum 1000 characters)
WORK EXPERIENCE (Most Recent First)
Employer Address Job Title Specific Duties (Maximum 1000 characters)
(Include voluntary work and military experience) Telephone Number
From (Month/Year) To (Month/Year) Hours Per Week Last Salary Supervisor
Number Employees Supervised
Reason For Leaving Employer Address Job Title Specific Duties (Maximum 1000 characters) Telephone Number
May We Contact This Employer?
Yes
No
From (Month/Year) To (Month/Year) Hours Per Week Last Salary Supervisor
Number Employees Supervised
Reason For Leaving Employer Address Job Title Specific Duties (Maximum 1000 characters) Telephone Number
May We Contact This Employer?
Yes
No
From (Month/Year) To (Month/Year) Hours Per Week Last Salary Supervisor
Number Employees Supervised
Reason For Leaving Employer Address Job Title Specific Duties (Maximum 1000 characters) Telephone Number
May We Contact This Employer?
Yes
No
From (Month/Year) To (Month/Year) Hours Per Week Last Salary Supervisor
Number Employees Supervised
Reason For Leaving
May We Contact This Employer?
Yes
No
I certify the information contained in this application is true, correct, and complete. I understand that, if employed, false statements reported on this application may be considered sufficient cause for dismissal.
Signature of Applicant_________________________________________________________ Date________________ Interviewers Comments:
WorkSource Washington and Washington State Employment Security are equal opportunity employers and providers of employment and training services. Auxiliary aids and services are available to persons with disabilities upon request.
