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APPLICATION

FOR EMPLOYMENT

YOUR COMPANY NAME

Address

City, State Zip

Phone (123) 456-7890

Fax (123) 456-7890

We consider applications for all positions without regard to race, color, religion, creed, sex, national origin, disability, marital status, sexual orientation and citizenship status.

	(PLEASE PRINT)
Position(s) Applied For		Date of Application
Position(s) Applied For		Date of Application

How Did You Learn About Us?

■Advertisement ■ Friend ■ Inquiry ■ Employment Agency ■ Relative ■ Other _____________________________

Last Name			First Name					Middle Name

Address	Number	Street			City			State	Zip Code

Telephone Number(s)								Social Security Number (voluntary)
Best time to contact you at home is:									. . . . . . . . . . ____:_______ PMAM
Best time to contact you at home is:			. . . . . . . . . . . . . .	. . . .	. . . . . . .	. . . . . . . . . . . .	.	. . . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . ____:_______ PMAM
If you are under 18 years of age, can you provide required proof of your eligibility to work?								. . . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . Yes	No
Have you ever filed an application with us before? If Yes, give date					_____________		.	. . . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . Yes	No
Have you ever been employed with us before? If Yes, give date				_____________			.	. . . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . Yes	No
Do any of your friends or relatives, other than spouse, work here? .					. . . . . . .	. . . . . . . . . . . .	.	. . . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . Yes	No
If Yes, state name, relationship and location ___________________________________
Are you currently employed?			. . . . . . . . . . . . . .	. . . .	. . . . . . .	. . . . . . . . . . . .	.	. . . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . Yes	No
May we contact your present employer?			. . . . . . . . . . . . . .	. . . .	. . . . . . .	. . . . . . . . . . . .	.	. . . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . Yes	No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment									. . . . . . . . . . Yes	No
Date available for work		______________	What is your desired salary range?					______________
Are you available to work:		Full Time	(Please indicate	1	2 3	shift)
		Part Time	(Please indicate	Mornings		Afternoon Evenings)
		Temporary	(Please indicate dates available __________					- __________)

Are you currently on “lay-off” status and subject to recall?		. . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . . .	Yes	No
Can you travel if a job requires it?	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . . . . . . . . . . . . . .	. . . . . . . . . . . .Yes	No
Have you been convicted of a felony within the last five years?		. . . . . . . . . . . . . . . .		Yes	No
A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.
EDUCATION
School	Name and Address	Course of Study	No. of Years	Diploma /
School	of School	Course of Study	Completed	Degree
	of School		Completed	Degree
High School

Undergraduate College

Graduate/Professional

Other (Specify)

ADDITIONAL INFORMATION

State any additional information you feel may be helpful to us in considering your application, including any job related training in the U.S. Military.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have

applied? A review of the activities involved in such a job or occupation has been given.

____ YES

____ NO

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities. Exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer	Dates Employed		Work Performed
	From	To	Work Performed
Address	From	To



Telephone Number(s)
Telephone Number(s)	Hourly Rate/Salary
	Hourly Rate/Salary
Starting/Present Job Title	Starting	Final


Supervisor

Reason for Leaving		May We Contact	Yes	No

Employer	Dates Employed			Work Performed
Employer	Dates Employed
	From	To
Address	From	To



Telephone Number(s)
Telephone Number(s)	Hourly Rate/Salary
	Hourly Rate/Salary
Starting/Present Job Title	Starting	Final


Supervisor

Reason for Leaving		May We Contact	Yes	No

Employer	Dates Employed			Work Performed
	From	To		Work Performed
Address	From	To



Telephone Number(s)
Telephone Number(s)	Hourly Rate/Salary
	Hourly Rate/Salary
Starting/Present Job Title	Starting	Final
Starting/Present Job Title

Supervisor

Reason for Leaving

May We Contact

Yes

REFERENCES Do not include family members or past supervisors.

Name	Phone Number

Best Time to Call

Occupation

APPLICANT'S STATEMENT

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employ- ment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specif- ically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I under- stand, also, that I am required to abide by all rules and regulations of the Employer.

Signature of Applicant

Date

This Application For Employment is sold for general use throughout the United States. Amsterdam Printing & Litho assumes no responsibility for the use of said form or any questions which, when asked by the employer of the job applicant, may violate State and/or Federal Law.

Rev 10/05 From AMSTERDAM PRINTING AND LITHO, Amsterdam, N.Y. 12010 1-800-833-6231

AMSTERDAM

Question	Answer
Form Name	Amsterdam Print Litho Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	amsterdam application employment form, 1999, disabilities, amsterdam application for employment

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