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APPLICATION Example job .pdf


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APPLICATION FOR EMPLOYMENT 

PRE­EMPLOYMENT QUESTIONAIRE 
EQUAL OPPORTUNITY EMPLOYER

PERSONAL INFORMATION: 

DATE:  December 1, 2007 

Name (Last, First, Middle) 

Social Security Number: 
123­45­6789 

Smith, Jane 
Present address (Street, City, State, Zip) 
1220 Monterey Street, Hollister, CA 95023 
Phone number: 

Referred by:  Sam Smith 

(831) 637­5831 

EMPLOYMENT DESIRED: 
Position: 

Open or Name of 
Position 

Are you currently employed? 

Date you can start:  Immediately 
YES 

Salary desired:  Open 

NO  If so, May we inquire of your present employer?  YES  NO 

Ever applied to this company before?  YES  NO  Where? 

N/A 

When?  N/A 

EDUCATION: 
SCHOOL                          NAME AND LOCATION 

GRADUATED 

MAJOR SUBJECTS 

Yes          No 

HIGH SCHOOL 

San Benito High School 
1220 Monterey St. 
Hollister, CA 95023 



General Education 

CONTINUING 
EDUCATION 
COLLEGE 

OTHER 

OTHER INFORMATION: 
Special Training/Courses: 
Computer Applications I & II; Teacher Aide; Consumer Foods, ROP class 
Special Skills for This Employment: 
Computer literate; Hard working; Good customer services skills; Organized and Creative; Punctual; Bilingual 
Activities and Interests: 
Soccer; Drama Class; Gardening; Painting; Reading 
EXCLUDE ORGANIZATIONS, THE NAME OR CHARACTER OF WHICH INDICATES THE RACE, CREED, SEX, MARITAL STATUS, AGE, COLOR, OR 
NATIONAL ORIGIN OF ITS MEMEBERS. 

CURRENT AND FORMER EMPLOYERS: 
DATES 
FROM: 8/2007 
______________ 
TO: Present 

(LIST MOST RECENT EMPLOYMENT FIRST) 
REASON FOR 
LEAVING 
Premier Cinemas 
$  8.00 
_________________________________________ 
Usher 
N/A 
641 McCray Street, Hollister, CA 95023 
PER: Hour 
(831) 638­1688 

NAME AND ADDRESS OF EMPLOYER     WAGES          POSITION 

FROM: 6/2006 
______________ 
TO:  8/2004 

Hazel Hawkins Hospital 

FROM: 5/2004 
______________ 
TO:  6/2001 

Gilroy Gardens 

$  7.50 
_________________________________________ 
911 Sunset Drive, Hollister CA 95023 
PER: Hour 
(831) 637­5711 
$  6.75 
_________________________________________ 
3050 Hecker Pass HWY, Gilroy CA 95020 
PER: Hour 
(408) 842­2121 

Diet Aide 

Career Change 

Host 

Seasonal 

REFERENCES: (GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU) 
NAME 
ADDRESS & PHONE 
BUSINESS 

YEARS 
KNOWN 

Rev. John Johnson 

St John’s Church, 4 th  Street, Hollister CA (800) 630­1234 

Minister 



Elaine Russell 

109 Central, Hollister CA (101) 444­6000 

Secretary 



Kathy Jones 

1220 Monterey Street, Hollister CA (800) 123­4567 

Teacher 



INCASE OF EMERGENCY, NOTIFY: 
Ruth Smith 
NAME 

1220 Monterey Street, Hollister                                     (831) 637­5831 
ADDRESS 
PHONE 

I authorize investigation of all statements contained in this application, I understand that misrepresentation or 
omission of facts called for is cause for dismissal.  Further, I understand and agree that my employment is for 
no definite period and may, at the discretion of the employer, be terminated at any time without any previous 
notice. 

SIGNED: _________________________________________ 

DATE: _____________________ 

APPLICANT – DO NOT WRITE BELOW THIS LINE 
Interviewed By: 
Remarks: 
Neatness: 
Ability: 
Hired: 
Start Date: 

Dept: 

Position: 
Salary: 

Approvals: 
____________________                                 _________________                               ________________ 
1.) Employment Manager                               2.) Employment Head                              3.) General Manager


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