Upper Cape Cod Regional Technical School

Sample Job Application

INSTRUCTIONS:
● Always complete job applications in blue or black ink.
● Make sure your writing is neat and legible.
● Complete this sample application using ​your own personal information.
● Include all applicable information, dates, and addresses.
● Note that the space for Social Security Number has been filled in with random
numbers to protect that piece of your personal information. When completing
an actual application, make sure you include your real Social Security Number
or you may not be contacted to schedule an interview.
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Acme Corporation
1234 Mockingbird Lane
Hyannis, MA 02601
(508) 123-4567
Acme Job Application
Complete all parts of this job application except those areas marked ​For Office Use
Only​. If your application is illegible, incomplete, or does not clearly answer the
question, your application may not be accepted. If you have no information to enter
into a box, please mark that box ​N/A​.

Name and Address

Name (First, Middle, Last) Social Security Number
​123-45-6789
Mailing Address

City, State, and Zip Code

Phone Number (home) Phone Number (cell)

E-Mail Address May we use e-mail to contact you?

Yes • No •

Additional Personal Information

Have you been an employee of Acme Corporation in the past?
Yes • No •
I certify that I am in compliance with the provisions of the Selective Service Act.
Yes • No • N/A, I am a female •
I certify that I am a U.S. citizen, permanent resident, or foreign national with legal authorization to work
in the United States.
Yes • No •
Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a
felony? If “yes,” please explain.
Yes • No •
 Education &​ Training
(Schools attended or special training received)
School From To Did you graduate?
Yes • No •

Location Type of degree or diploma

School From To Did you graduate?

Yes • No •

Location Type of degree or diploma

Work History
Job Title From To Hrs/Week Employer

Address Phone Supervisor’s Name May we contact

this employer?
Yes • No •
Reason for leaving?

Job Title From To Hrs/Week Employer

Address Phone Supervisor’s Name May we contact

this employer?
Yes • No •
Reason for leaving?

Job Title From To Hrs/Week Employer

Address Phone Supervisor’s Name May we contact

this employer?
Yes • No •
Reason for leaving?

MMS 07/17
 How did you find out about this position?
Current Job or Career State WERC Company Employment
Employee Fair Website Newsletter Service
• • • • •
Monster.com Other Internet Newspaper Prof. Org. Radio/TV
Advert. Website Advert.
• • • • •
Recruiter University or Other (please describe):
College Advisor
• •

Job/Shift Desired
Full Time Part Time Permanent Temporary 6 Month
• • • • •
9 Month Seasonal Limited Service Shift Night
• • • • •

Signature Date

I hereby certify that all answers and statements on this application are true and
complete to the best of my knowledge. I understand that should an investigation
disclose untruthful or misleading answers, my application my be rejected, my name
removed from consideration, or my employment from Acme Corporation terminated
without benefits.

WPM
For Office Use Only
RK WMM

Date of Interview? Date Application Submitted?

Clerical? Staff?
Yes • No • Yes • No •

MMS 07/17