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 ___________