An employer uses the following application form. Do you recommend that any question be removed from the application? Why? Rewrite the application so that it better meets legal requirements.

Name ________________________________________ Sex _________

Address ______________________________________ Date of Birth _________

City ____________________ State ____ Zip ______ Are you a U.S. citizen? ______

Place of birth __________________________________________________________

In case of emergency, who should be notified? ________________________________

Are you single? ____ married? ______ separated? _______ divorced? ________

Number of dependents ______ Do you hold a valid driver’s license? _________

Have you ever been employed by this company before? _______ When? _______

Are you a U.S. veteran?______ Years of service? _________

Type of discharge? __________________________________

Have you ever filed a workman’s compensation claim or been injured on the job? _____

Have you ever pled guilty to a crime? _______ If Yes, provide details. _____________


List all prior employment, including dates of employment, reason for leaving, address and
phone number of employer, and supervisor.




I understand that any misrepresentation or omission of material facts will result in non-hire or
termination of employment without notice or recourse.

Signature ___________________________________________ Date ___________

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