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Part-Time Job Application Form

Sample Part-Time Job Application

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Print out this sample part-time job application form. and complete it, so you know what information you'll need with you when you apply for a job.

Company Name

Part-Time Employment Application

Applicant Information

Applicant Name ___________________
Home Phone _____________________
Cell Phone _______________________
Email Address ____________________

Current Address:
Number and street _______________________
City _________________________________
State & Zip _____________________________

How were you referred to Company?:________________________

Positions

Position(s) applying for:________________________________

Are you applying for:

  • Temporary part-time work – such as summer or holiday work? [ ] Y or [ ] N
  • Regular part-time work? [ ] Y or [ ] N
What days and hours are you available for work?___________________________________________

If applying for temporary work, when will you be available? ___________________________________________

If hired, on what date can you start working? ___ / ___ / ___

Can you work on the weekends? [ ] Y or [ ] N

Can you work evenings? [ ] Y or [ ] N

Personal Information:

Have you ever applied to / worked for Company before? [ ] Y or [ ] N
If yes, please explain (include date): ________________________

If hired, would you have transportation to/from work? [ ] Y or [ ] N

Are you over the age of 18? If under 18, do you have working papers? [ ] Y or [ ] N

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? [ ] Y or [ ] N

If hired, are you willing to submit to and pass a controlled substance test? [ ] Y or [ ] N

Have you ever been convicted of a criminal offense (felony or misdemeanor)? [ ] Y or [ ] N

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case.____________________________________________

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense.

Education, Training and Experience

High School:
School name: ________________________
School address:________________________
School city, state, zip:________________________________

Number of years completed: _______________
Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: _______________

College / University:
School name: __________________________
School address:________________________
School city, state, zip:________________________________

Number of years completed: ________
Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: __________________

Vocational School:
Name: ________________________
Address:______________________
City, state, zip:________________________________

Number of years completed: ________
Did you graduate? [ ] Y or [ ] N
Degree / diploma? : __________________

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