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?
If yes, please explain.
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
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?
Hourly wage or salary desired?
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
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
seeking? (Circle one)
Full-time Part-time Seasonal Temporary
Days and Hours Available:
______ Monday
______ Tuesday
______ Wednesday
______ Thursday
______ Friday
______ Saturday
______ Sunday
Hours Available: ______ to ______
Hours Available: ______ to ______
Hours Available: ______ to ______
Hours Available: ______ to ______
Hours Available: ______ to ______
Hours Available: ______ to ______
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, what is their name?
If yes, call your friend or relative and ask if you can put their name on the
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
GED?
______H.S. Diploma ______ 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
Grade Point Average (GPA)
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
Grade Point Average (GPA)
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
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
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
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
Explain any gaps in your
employment.
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.
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
How do you know this person?
Years Known
Person’s Name
Address
Telephone Number
How do you know this person?
Years Known
