Application for Employment

PERSONAL INFORMATION
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Business Phone
Email*
Are you legally authorized to work in the United States?*
- Yes
- No
Position You Are Applying For*
I am interested in:
- Full-Time
- Part-Time
- Either Full- or Part-Time
I am available to work on the following days (hold down the Shift or Ctrl key to select multiple days):
Desired Salary
Referred By
Date Can Start*

WORK HISTORY
Give information about your last 3 jobs, starting with the most recent.
EMPLOYER 1*
- Please check and provide details
Employer*
Dates Employed*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Ending Salary*
Titles/Duties*
Manager's Name and Title*
Reason for Leaving*
EMPLOYER 2
- Please check and provide details
Employer*
Dates Employed*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Ending Salary*
Titles/Duties*
Manager's Name and Title*
Reason for Leaving*
EMPLOYER 3
- Please check and provide details
Employer*
Dates Employed*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Ending Salary*
Titles/Duties*
Manager's Name and Title*
Reason for Leaving*

BUSINESS REFERENCES
If applying for your first job, you may use academic references.
Name (1)
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
Relationship to You
Name (2)
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
Relationship to You
Name (3)
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
Relationship to You

PLEASE READ AND SIGN

"UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100."
Signature*
First Last
Date*
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PERSONAL INFORMATION