APPLICATION FOR EMPLOYMENT

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 ordininces. WorkSource Washington and Washington State Employment Securit,;
are 1ot responsible for the mjsuse of information provided on this form. Provide all infonnation
requested 6y printing in ihr br typing. Usi
the 'TAB' key to move through the document.
GENERAL INFORMATION
Name (Last)
(First)
ACrdress (Maiting Address)
(city)
E-Mail
(Middle lnitial)
Home Telephone
()
(zip)
(State)
other Telephone
()
Address - .....Are you legally entitled to worX in the U.S.?
n
Yes
n
ruo
POSITION
Position Or Type Or empryrnentEEGiEE'
WillAccept:
Are you able to perform the essential functions of the job you are applying for,
with or
without reasonable accommodationl f] yes
f] No
5arary ueslred
n
I
f]
shift:
E
Part-time
I
rutt-lime
oay
swing
Graveyard
I
l-l Rotatinq
Temporary
Date Available
EDUCATION AND TRATNING
High School Graduate Or General Education (GED) Test passed?
lf no, list the highest grade completed
[
yes
n No
College, Business School, Military (tV6st recent first)
Name and Location
Dates
Attended
Month/Year
Credits Earned
Quarterly or
Other
Semester
(Specify)
Hours
From
Graduate
Degree
& Year
Major
or Subject
n Yes
ENo
D Yes
ENo
D Yes
nruo
To
From
To
From
To
From
n Yes
E
To
t'lo
Ltcense, certificate or Registration
Number
Where lssued
Expiration Date
License, Certificate or Registration
Number
Where lssued
Expiration Date
uccupattonat License, Certificate or Registration
Number
Where lssued
Expiration Date
Languages Read, Written or Spoken Fluenfly Other Than English
VETERAN INFORMATION
SPECIAL SKILLS
nent skills and
EMS 10171 CC 7540-032 635
ESD 1999 Rev.12l30l1i)
WORK EXPERIENCE
(lnclude
Employer
work and
TeteDhone Number (
From (Month/Year)
Job Title
Number Employees SuPervised
To (Month/Year)
Recent
I
Hours PerWeek
Last Salary
Supervisor
' May We
Reason For Leaving'
Contact Tnrs EmPloYer?-
Employer
Telephone Number (
From (MonthlYear)
Job Title
Number Employees Supervised
To (Month/Year)
Hours PerWeek
Last Salary
Supervisor
f,rf
Reason For Leaving
"V
w"
Contact This Employer?
Employer
Yes
n
No
To (Month/Year)
Number Employees Su Pervised
Job Title
fl
From (Month/Year)
Specifrc Outies (Maximum 1000 characters)
Hours Per Week
Last Salary
Supervisor
*r*"Contu"t@
Reason For Leaving
(
From (Month/Year)
Employer
Telephone Number
Job Title
Number EmPloyees SuPervised
)
To (Monthffear)
@racters)
Hours Per Week
Last Salary
Supervisor
*.V
Reason For Leaving
*"
contact rhis
tqg9l".Ltr-Y"t
nL
I understand that, if employed' false
certify the information contained in this application is true, correct, and complete,
dismissal'
statements reported on this application may be considered sufficient cause for
I
Date
Signature of APPI
I
nterviewer's Comments:
a"*irl"ry
"iai
are ed;Cpportuni-ty emPloyers and
and services are available to persons with disabilities upon request,
and training