Employment Application
For every field that is not applicable, please type “N/A”.
For all ‘From’ and ‘To’ fields please format as “2-digit month/2-digit year” (ie. January 2000: 01/00).
APPLICANT INFORMATION
Last Name
XXXX
Street Address
First
XXXX
XXXX
XXXX
State
Phone
XXXX
E-mail Address
Choose date
Position Applied For
XXXX
Apartment/Unit #
City
Date Available
M.I.
Social Security No.
XXXX
ZIP
XXXX
Desired Salary
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
Yes
No
If so, when?
XXXX
Have you ever been convicted of a felony?
Yes
No
If Yes, explain
XXXX
Are you able to relocate?
Yes
No
EDUCATION
XXXX
College
XXXX
From
XXXX
Other
XXXX
From
XXXX
XXXX
XXXX
No
XXXX
XXXX
XXXX
Yes
From
Choose date
XXXX
Are you a citizen of the United States?
High School
Date
To
XXXX
Did you graduate?
Yes
No
To
XXXX
Did you graduate?
Yes
No
Degree
XXXX
To
XXXX
Did you graduate?
Yes
No
Degree
XXXX
REFERENCES
Please list three professional references.
Full Name
XXXX
Relationship
Company
XXXX
Phone
Address
XXXX
Full Name
XXXX
Relationship
Company
XXXX
Phone
Address
XXXX
Full Name
XXXX
Relationship
Company
XXXX
Phone
Address
XXXX
XXXX
XXXX
XXXX
XXXX
XXXX
XXXX
Yes
No
PREVIOUS EMPLOYMENT
Company
XXXX
Phone
Address
XXXX
Supervisor
Job Title
XXXX
Responsibilities
From
XXXX
Starting Salary
/hr
XXXX
To
XXXX
Reason for Leaving
Address
XXXX
Supervisor
Job Title
XXXX
Starting Salary
/hr
XXXX
To
XXXX
Reason for Leaving
$ XXXX
/hr
$ XXXX
/hr
XXXX
Phone
Address
XXXX
Supervisor
Job Title
XXXX
XXXX
Ending Salary
XXXX
XXXX
From
/hr
XXXX
$ XXXX
Company
Responsibilities
$ XXXX
XXXX
Phone
XXXX
Ending Salary
XXXX
XXXX
From
XXXX
$ XXXX
Company
Responsibilities
XXXX
Starting Salary
$ XXXX
XXXX
/hr
Ending Salary
XXXX
To
XXXX
Reason for Leaving
XXXX
MILITARY SERVICE
Branch
XXXX
Rank at Discharge
From
XXXX
If other than honorable, explain
XXXX
Type of Discharge
To
XXXX
XXXX
XXXX
LANGUAGE PROFICIENCY
Refer to chart below for descriptions of proficiency levels. If you are proficient at additional languages, please state them on your resume.
Language
English
Proficiency Level
XXXX
Language
XXXX
Proficiency Level
XXXX
Language
XXXX
Proficiency Level
XXXX
SOFTWARE PROFICIENCY
Refer to chart below for descriptions of proficiency levels. If you are proficient with additional software, please state them on your resume.
Microsoft Word
Proficiency Level
XXXX
Microsoft Excel
Proficiency Level
XXXX
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature
Date
LANGUAGE PROFICIENCY LEVELS
Level 1 – Elementary
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Can fulfill travelling needs and conduct themselves in a polite manner
Able to use questions and answers for simple topics within a limited level of experience
Able to understand basic questions and speech, which allows for guides, such as slower speech or repetition, to aid understanding
Has only a vocabulary large enough to communicate the most basic of needs; also makes frequent punctuation and grammatical mistakes in
writing of the language
Able to perform most basic functions using the language. This includes buying goods, reading the time, ordering simple meals and asking for
minimal directions.
Level 2 – Limited Working
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Able to satisfy routine social demands and limited work requirements
Can handle with confidence most basic social situations including introductions and casual conversations about current events, work, family,
and autobiographical information
Can handle limited work requirements, needing help in handling any complications or difficulties; can get the gist of most conversations on
non-technical subjects (i.e. topics which require no specialized knowledge), and has a speaking vocabulary sufficient to respond simply with
some circumlocutions
Has an accent which, though often quite faulty, is intelligible
Can usually handle elementary constructions quite accurately but does not have thorough or confident control of the grammar.
Level 3 – Professional Working
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Able to speak the language with sufficient structural accuracy and vocabulary to participate effectively in most conversations on practical,
social, and professional topics
Can discuss particular interests and special fields of competence with reasonable ease
Has comprehension which is quite complete for a normal rate of speech
Has a general vocabulary which is broad enough that he or she rarely has to grope for a word
Has an accent which may be obviously foreign; has a good control of grammar; and whose errors virtually never interfere with understanding
and rarely disturb the native speaker.
Level 4 – Full Professional
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Able to use the language fluently and accurately on all levels normally pertinent to professional needs
Can understand and participate in any conversations within the range of own personal and professional experience with a high degree of
fluency and precision of vocabulary
Would rarely be taken for a native speaker, but can respond appropriately even in unfamiliar situations
Makes only quite rare and unpatterned errors of pronunciation and grammar
Can handle informal interpreting from and into the language.
Level 5 – Native or Bilingual

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Has a speaking proficiency equivalent to that of an educated native speaker
Has complete fluency in the language, such that speech on all levels is fully accepted by educated native speakers in all of its features,
including breadth of vocabulary and idiom, colloquialisms, and pertinent cultural references.
SOFTWARE PROFICIENCY LEVELS
Microsoft Word
Level 1 – Basic

Create a new document, enter text, and save it.

Open and edit existing documents.
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Navigate in a document and perform a search.

Select and move text.
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Format characters and paragraphs; work with tabs, indents, margins, lists, breaks, spacing.

Use AutoCorrect and Help tools.
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Create and edit tables.

Control page and document appearance.

Print documents, envelopes, and labels.
Level 2 – Intermediate
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Work with sections, create templates, use styles, and customize them.
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Create and format complex tables, and manage table data.
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Create Mail Merges, sort and filter them.

Customize Toolbars.
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Insert graphic elements.
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Run and record Macros.

Create a Web Page based on a template and add hyperlinks.
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Create a Web Page based on a template and add
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hyperlinks.
Level 3 – Advanced
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Microsoft Excel
Work with advanced styles and AutoFormat features, linking styles.
Use graphic effects such as dropped capital letters and clip art, insert WordArt, and draw in a document.
Work with very large documents that require a table of contents, footnotes, endnotes, and crossreferences.
Manage and track document changes, using highlights and comments.
Insert multimedia elements in a Web Page.
Manage Macro commands, create dialogue boxes, and understand the notions of Visual Basic Application programming.
Level 1 – Basic

Plan, conceive, create, save, manage, and maintain a database.

Modify a database structure.
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Generate new records and modify them.
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Create tables with Table Wizard and in Design View and work with them.
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Find, edit, filter, and sort records.
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Create and use ‘select queries’ to view specific records and to perform calculations.
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Create, use, and customize forms, and reports.
Level2 – Intermediate
Work with Data Access Pages.
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Create, modify, and format charts.
Use graphic objects to enhance worksheets and charts.
Filter data and manage a filtered list.
Perform multiple-level sorting, use sorting options, and design considerations.
Use mathematical, logical, statistical, and financial functions.
Group and dissociate data and perform interactive analysis.
Create and modify some macro commands.
Level 3 – Advanced
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Customize the work area.
Use advanced functions (Names, VLOOKUP, IF, IS).
Work with pivot tables.
Use spreadsheet web components.
Manage macro commands: concepts, planning, operations, execution, modification, interruption.
Use personalized toolbars.
Perform some programming in VBA.