This document is a sample job application form for a position at 1501 Oak Street in Kansas City, MO. It requests personal information like name, address, phone number, and availability. It also asks about the applicant's employment history, physical limitations, and willingness to undergo a physical exam or substance abuse test. The form notes that all applicants will receive equal consideration regardless of attributes like race, religion, or disability status.

1. This I-Form is a Sample for Demonstration Purposes Only
1501 Oak Street, Kansas City, MO 64108
816-474-4797 Fax 816-842-4477
APPLICATION FOR EMPLOYMENT
Each applicant will be given employment consideration based on individual merit, Submit Clear Cancel
without regard to the individual’s race, color, religion, sex, national origin, the
presence of a non-job related medical condition or handicap, or other categories Email
governed by applicable law. We are an equal opportunity employer.
Form Number
PERSONAL INFORMATION Today’s Date
Soc. Sec.
Name Number
LAST FIRST MIDDLE
Current Address
CITY STATE ZIP
Former Address
CITY STATE ZIP
Home Telephone ( ) Referred by
Other Telephone ( ) Are You at Least 18 Years of Age?
FOR OUR REFERENCE
Annual
Position Salary Date
Desired Desired Available
Ever Work Ever Apply Related to
Here Before? Here Before? Anyone Here?
Are You Will Present Employer
Employed Now? Give A Reference Now?
In Case of Emergency Contact
NAME RELATIONSHIP TELEPHONE
ADDRESS CITY STATE ZIP
PHYSICAL DATA
Do You Have Any Physical or Mental Limitations Which Would Restrict Your Job Performance?
If Yes, Explain
Are You Willing To Take a Pre-Employment Physical Examination?
Are You Willing To Take a Pre-Employment Substance Abuse Test?
EMPLOYMENT HISTORY (LIST YOUR LAST 3 EMPLOYERS, BEGINNING WITH THE CURRENT OR MOST RECENT ONE FIRST.)
DATES OF SALARY
EMPLOYMENT NAME AND ADDRESS OF EMPLOYER BEG./END. POSITION REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO