Washington State
Department of Services for the Blind

 


Sample Job Application

 

 

The questions asked on this handout are commonly found on actual job applications.  Carefully consider each question and respond with answers that are clear, concise, and relevant.  By preparing your responses ahead of time, you will be better equipped to provide your potential employers with information that is eloquent and accurate.

 

Your Name:

 

 

Social Security Number:

 

Date of Birth:

 

 

Mailing Address:

 

 

 

 

 

 

Home Telephone Number:

 

Work Telephone Number:

 

 

Position Desired:

 

Salary Desired:

 

 

In which geographical areas will you consider working? (List them.)

 

 

 

 

 

 

 

 

 

What types of employment will you accept? (Check all that apply.)

Day Shift

 

Swing Shift

 

Graveyard Shift

 

Rotating Shift

 

 

What type of work schedule will you accept? (Check all that apply.)

Full-Time

 

Part-Time

 

 

Temporary

 

Tandem (Shared)

 

 

Project

 

 

Seasonal

 

 

Intermittent (On-Call)

 

 

What language(s) do you speak? (List them.)

 

 

 

 

 

Have you ever been convicted of a crime?

Yes

 

No

 

 

Do you have keyboarding or computer skills?

Yes

 

No

 

 

How many words per minute can you type?

 

What software programs are you proficient in?

 

 

 

 

 

What is the highest level of education you have achieved?

(Check all that apply.)

 

Some primary education

(grade or elementary school)

 

Highest level completed

 

 

Some secondary education

(high school or GED preparation)

 

Highest level completed

 

 

High school graduate or GED certificate recipient

 

 

Some post-secondary education (college or university)

 

Highest level completed:

 

 

Some vocation/technical school education

 

Highest level completed:

 

 

2-year degree

 

 

Major(s):

 

 

4-year degree

 

 

Major(s):

 

 

Master’s degree

 

 

Major(s):

 

 

Doctoral degree

 

 

Major(s):

 

Other post high school training

 

Specify Type(s):

 

 

What is the history of your post-primary education? (E.g. high schools attended, colleges attended, etc.)

School Name and Location:

Month and Year Attended:

 

1.

From:

 

 

To:

 

 

2.

From:

 

 

To:

 

 

3.

From:

 

 

To:

 

 

4.

From:

 

 

To:

 

 

5.

From:

 

 

To:

 

 

6.

From:

 

 

To:

 

 

7.

From:

 

 

To:

 

 

8.

From:

 

 

To:

 

 

9.

From:

 

 

To:

 

 

10.

From:

 

 

To:

 

 

 

What is the history of your employment? (Start with your present or last position, then work backwards.)

 

1. Name of Present or Last Employer:

 

 

Address of Employer:

 

 

 

 

 

 

Telephone Number of Employer:

 

 

Your Title:

 

 

Months and Years Employed in this Position

From:

 

To:

 

 

Total Months Employed in this Position:

 

Average Hours Worked Per Week:

 

 

Last Salary (If volunteer, write “volunteer”):

 

 

Name of Immediate Supervisor:

 

 

Reason for Leaving:

 

 

Number of Employees Supervised:

 

 

Specific Duties:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Name of Previous Employer:

 

 

Address of Employer:

 

 

 

 

 

 

Telephone Number of Employer: