Sample Job Application

SAMPLE JOB APPLICATION
The following sample job application will give you a good idea of what to expect as you apply for a job. It also
contains the type of information that you should have prepared prior to beginning any job application, whether
you apply online or in-person.
APPLICANT INFORMATION
Your Full Legal Name

Do you have a nickname?
Your Address
City/State/Zip Code
Home Telephone
Cell Phone
E-mail Address
Are you 18 years of age or

older?
Are you a United States
Citizen?
Are you legally eligible for
employment within the
United States?
Have you served in the

United States Armed Forces?
If yes, provide dates.
Branch
Highest Rank
Duties and Skills
Are you a current member of

the National Guard or
Reserves?
If yes, provide your Rank
Duties and Skills
Have you ever been convicted

of a felony?
Note: You don’t want the details of any conviction stored in an employer’s
computer files or databases. In the space where you are asked to provide
If yes, please explain. details, simply write, “Will explain during interview” or “Please see me.”
During the interview, you can explain what happened (and how you have
learned and grown since then).
EMPLOYMENT DESIRED
Which position are you

seeking?
Note: Don’t give a salary on the application. You may price yourself out of
the job if your number is too large or you may look desperate if you’re asking
Hourly wage or salary desired?
too little. Instead, just write, “Standard wage” or put the salary listed in the
position description if you must fill in a number.
What type of work are you

Full-time Part-time Seasonal Temporary
seeking? (Circle one)
______ Monday Hours Available: ______ to ______
______ Tuesday Hours Available: ______ to ______
______ Wednesday Hours Available: ______ to ______
Days and Hours Available: ______ Thursday Hours Available: ______ to ______
______ Friday Hours Available: ______ to ______
______ Saturday Hours Available: ______ to ______
______ Sunday Hours Available: ______ to ______
Are you available to work
holidays?
Are you available for
overtime?
When will you be available to
begin work?
If hired, will you have reliable
transportation to and from
work?
Have you ever been employed

with us in the past?
If yes, what was your job title
and department?
Supervisor’s Name and Phone
Number
Location of Employment
Dates of Employment
Reason for Leaving
Do you have a friend or

relative that is employed by
us?
If yes, call your friend or relative and ask if you can put their name on the
If yes, what is their name?
application. Also, ask if they would put in a good word for you.
Job Title and Department
Location of Employment
Phone Number
EDUCATION
Name of High School or

Vocational School attended
Address
City/State/Zip Code
Dates of Attendance
Highest Grade Completed
Grade Point Average (GPA)
Do you have a Diploma or
______H.S. Diploma ______ GED
GED?
Program or Specialty
Activities (Sports, Groups,
Clubs)
Honors or Awards
Name of College or University

Attended
Address
City/State/Zip Code
Dates of Attendance
Degree or Certificate Attained
Major or Specialty
Activities (Sports, Clubs,
Groups)
Honors or Awards
Name of College or University

Attended
Address
City/State/Zip Code
Dates of Attendance
Degree or Certificate Attained
Major or Specialty
Activities (Sports, Clubs,
Groups)
Honors or Awards
EMPLOYMENT HISTORY
With your employment history, start with your most recent work and then go backwards from there to end with
your very first job (or with about 7 to 10 years of work history). If you don’t have this much work history, that
is okay! If your work history is sparse, include more informal jobs like lawn care, coaching, volunteering, self-
employment, and freelance work.
Name of Most Recent

Employer
Address
City/State/Zip Code
Dates of Employment
Hours Worked per Week
Your Salary $_________ per ___________ (hour, week, month, year, etc)
Your Job Title
Your Primary Job Duties
What skills did you develop
while working this job?
Your Accomplishments
Supervisor’s Name
Supervisor’s Phone Number
Supervisor’s E-mail Address
May we contact him or her?
Reason for Leaving
Name of Next Most Recent

Employer
Address
City/State/Zip Code
Dates of Employment
Your Job Title
Supervisor’s Name
Reason for Leaving

Employer
Address
City/State/Zip Code
Dates of Employment
Your Job Title
Supervisor’s Name
Reason for Leaving

Employer
Address
City/State/Zip Code
Dates of Employment
Your Job Title
Supervisor’s Name
Reason for Leaving
If you have any gaps between jobs, explain the gaps here. You do not need to
provide a lot of details, just the quick reasons.
Explain any gaps in your
employment.
ADDITIONAL INFORMATION
Do you speak any other

languages?
Do you have any other
qualifications or certifications?
Do you hold any professional
licenses or certifications?
What are your special skills?
Any other information that

would be helpful when
considering your application?
REFERENCES
A reference is someone who can testify to your character and abilities. Employers, coaches, teachers, volunteer
leaders, coworkers, mentors, clergy, etc.
Before you offer anyone’s name as a reference, make sure you have that person’s permission.
Person’s Name
Address
Telephone Number
How do you know this person?
Years Known
Person’s Name
Address
Telephone Number
Years Known
Person’s Name
Address
Telephone Number
Years Known

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SAMPLE JOB APPLICATION

Your Full Legal Name

Are you 18 years of age or

Have you served in the

Are you a current member of

Have you ever been convicted

Which position are you

What type of work are you

Have you ever been employed

Do you have a friend or

Name of High School or

Name of College or University

Name of College or University

Name of Most Recent

Name of Next Most Recent

Name of Next Most Recent

Name of Next Most Recent

Do you speak any other

What are your special skills?

Any other information that

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