State of Utah Employment Application

State of Utah
Department of Workforce Services
EMPLOYMENT APPLICATION
DWS-WDD 305
Rev. 3/2013
Employer:
Date:
Name:
Last
First
M.I.
Address:
Street address
City
State
Home phone:
Work phone:
Email address:
Are you a veteran?
Yes
ZIP
No
List the positions you are interested in by specific title (typist, carpenter, auto mechanic)
st
1 choice:
2
Available to work:
Full time
choice:
Temporary
Date you can start:
Are you employed now?
nd
Part time
Shift work
Desired salary:
Yes
No
Have you applied to this company before?
If yes, may we contact your present employer?
Yes
No
Where?
Yes
No
When?
Trade or professional licenses,
certificates or registrations:
References: Three persons not related to you whom you have known at least one year:
Name
Address
Telephone/Business/Occupation
Education:
High School Graduate?
Yes
No
College, Business or Trade Schools
(Name and Location)
If no, indicate highest grade completed (1–12):
Major or Vocational Subjects
Length of Time
Degree/Certificate
Continued on other side
Work History: Beginning with the present or most recent, list your three most significant employers. If you
wish to elaborate, you may attach a supplemental sheet or resume. Include military service, if applicable.
Firm name:
Dates of employment:
Address:
Street address
City
State
ZIP
State
ZIP
State
ZIP
Job title, responsibilities and duties:
Firm name:
Dates of employment:
Address:
Street address
City
Job title, responsibilities and duties:
Firm name:
Dates of employment:
Address:
Street address
City
Job title, responsibilities and duties:
Additional qualifications and skills: machines, equipment, tools used, related activities, etc.
Certification of Applicant:
I certify that all statements made in this application are true and correct and that any misstatement of
material facts may subject me to disqualification or dismissal. Also, I authorize verification of all statements
made in this application.
Signature:
Date:
Equal Opportunity Employer Program
Auxiliary aids and services are available upon request to individuals with disabilities by calling (801) 526-9240. Individuals
with speech and/or hearing impairments may call Relay Utah by dialing 711. Spanish Relay Utah: 1-888-346-3162