Application Form For Employment
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1
2APPLICATION 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)
(First)
(Middle Initial)
Home Telephone
(
)
-
Address (Mailing Address)
(City)
(State)
(Zip)
Other Telephone
(
)
-
E-Mail Address
Yes
No
Are you legally entitled to work in the U.S.?
POSITION
Position Or Type Of Employment Desired
Will Accept:
Shift:
Part-Time
Day
Full-Time
Swing
Are you able to perform the essential functions of the job you are applying for, with or
Temporary
Graveyard
Yes
No
without reasonable accommodation?
Rotating
Salary Desired
Date Available
EDUCATION AND TRAINING
Yes
No
High School Graduate Or General Education (GED) Test Passed?
If no, list the highest grade completed
College, Business School, Military
(Most recent first)
Credits Earned
Dates
Quarterly or
Degree
Major
Name and Location
Attended
Graduate
Other
Semester
& Year
or Subject
Month/Year
(Specify)
Hours
From
Yes
No
To
From
Yes
No
To
From
Yes
No
To
From
Yes
No
To
Occupational License, Certificate or Registration
Number
Where Issued
Expiration Date
Occupational License, Certificate or Registration
Number
Where Issued
Expiration Date
Occupational License, Certificate or Registration
Number
Where Issued
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 300 characters)
EMS 10171 CC 7540-032 635
ESD 1999 Rev. 12/30/03
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Parent category: Business