HRM410: Strategic Staffing Application Form Assignment YOUR NAME: You are the new HR manager for this fictitious (private sector) company, which has hundreds of employees and is clearly obligated under Title VII and other major employment regulations. Rather than starting over from scratch with a brand new application form, many HR managers would likely take a look at the existing form first. Using the table located at the very bottom of this document, identify the ten (10) items that are legally problematic* on this employment application form, why they are problematic, and what could possibly be in their place, if applicable. Use of the table is required. When you are done “save” or “save as” this document with your last name, then first initial and assignment name (e.g. SmithLApplForm.docx) and place your name in the table box above. Then load it to your Dropbox by end of Week 6. Please email your instructor if you have any questions. *By problematic we are looking for possible violations of various employment regulations. Note that some may not be blatantly illegal, but, rather problematic and best to avoid as a best practice. One final tip: Do not focus on stylist elements such as the layout of the application form or questions you do not “like.” Focus only on the legally problematic items. Today’s DateAPPLICATION FOR EMPLOYMENT ABC Payroll Company An Equal Opportunity Employer Position applying for: Desired Rate of Pay $ per PLEASE PRINT This application form has been reviewed for fairness and job-relatedness. Do not provide any unsolicited information. Disabled applicants can request reasonable accommodation in completing this application. Resumes are not accepted in lieu of completion of this application. Mr./Mrs./Ms./Miss Last Name First, Middle Initial Maiden Name (if applicable) ( ) Present Address Street City/State/Zip Telephone Number (day) ( ) ( ) Email Address (if applicable) Telephone Number (evening) Telephone Number (alternate) Are you a citizen of the United States? |_| Yes |_| No Are you legally eligible to work in this country? |_| Yes |_| No Have you ever been convicted of a felony or arrested? |_| Yes |_| No If yes, give dates and explain. (Attach separate paper if necessary.) This does not automatically mean you will not be hired. The basis of the situation and how long ago are important. Give all of the facts so that an informed decision can be made. Are you at least 18 years of age? |_| Yes |_| No Date available for employment: EDUCATIONAL DATA School Print Name, City, and State for Each School Dates (mo/yr) of Attendance Degree Major Course of Study High School College Graduate School Other Have you had any additional educational experience (other than data noted above), which relates to the job for which you are applying? |_| Yes |_| No If yes, describe: Pa.

1. HRM410: Strategic Staffing
Application Form Assignment
YOUR NAME:
You are the new HR manager for this fictitious (private sector)
company, which has hundreds of employees and is clearly
obligated under Title VII and other major employment
regulations. Rather than starting over from scratch with a brand
new application form, many HR managers would likely take a
look at the existing form first.
Using the table located at the very bottom of this document,
identify the ten (10) items that are legally problematic* on this
employment application form, why they are problematic, and
what could possibly be in their place, if applicable. Use of the
table is required.
When you are done “save” or “save as” this document with your
last name, then first initial and assignment name (e.g.
SmithLApplForm.docx) and place your name in the table box
above. Then load it to your Dropbox by end of Week 6.
Please email your instructor if you have any questions.
*By problematic we are looking for possible violations of
various employment regulations. Note that some may not be
blatantly illegal, but, rather problematic and best to avoid as a
best practice.

2. One final tip: Do not focus on stylist elements such as the
layout of the application form or questions you do not “like.”
Focus only on the legally problematic items.
Today’s DateAPPLICATION FOR EMPLOYMENT
ABC Payroll Company
An Equal Opportunity Employer
Position applying for:
Desired Rate of Pay
$ per
PLEASE PRINT This application form has been reviewed for
fairness and job-relatedness. Do not provide any unsolicited
information. Disabled applicants can request reasonable
accommodation in completing this application. Resumes are not
accepted in lieu of completion of this application.
Mr./Mrs./Ms./Miss
Last Name
First, Middle Initial
Maiden Name
(if applicable)
( )
Present Address
Street
City/State/Zip

3. Telephone Number (day)
( )
( )
Email Address (if applicable)
Telephone Number (evening)
Telephone Number (alternate)
Are you a citizen of the United States? |_| Yes |_| No
Are you legally eligible to work in this country? |_| Yes |_|
No
Have you ever been convicted of a felony or arrested? |_| Yes
|_| No If yes, give dates and explain. (Attach separate paper if
necessary.) This does not automatically mean you will not be
hired. The basis of the situation and how long ago are
important. Give all of the facts so that an informed decision
can be made.
Are you at least 18 years of age?
|_| Yes
|_| No
Date available for employment:
EDUCATIONAL DATA
School
Print Name, City, and State for Each School
Dates (mo/yr) of Attendance
Degree
Major Course of Study
High School

4. College
Graduate School
Other

5. Have you had any additional educational experience (other than
data noted above), which relates to the job for which you are
applying? |_| Yes |_| No
If yes, describe:
Page 1 of 4
EMPLOYMENT EXPERIENCE
List former jobs (most recent job first). ALL SECTIONS
MUST BE COMPLETED. Account for all time periods
including self-employment and military service. If you have
military service, please note specifics of discharge, dates, etc.
(Attach separate sheet(s), if necessary).
Employer
Dates Employed
Immediate supervisor
From
To
Address
Job Title
Telephone Number:
Work Performed

6. Reason for Leaving
Employer
Dates Employed
Immediate supervisor
From
To
Address
Job Title
Telephone Number:
Work Performed
Reason for Leaving
Employer
Dates Employed
Immediate supervisor

7. From
To
Address
Job Title
Telephone Number:
Work Performed
Reason for Leaving
Employer
Dates Employed
Immediate supervisor
From
To
Address
Job Title
Telephone Number:
Work Performed

8. Reason for Leaving
Page 2 of 4
EMPLOYMENT HISTORY
Have you ever been dismissed or forced to resign from an
employment? |_| Yes |_| No
If yes, please explain.
May we contact your present employer? |_| Yes |_| No
Previous employers? |_| Yes |_| No
Please identify any exceptions and reasons for not contacting
present or prior employers.
Please list any day(s), time(s) that you are not available to
work:
SKILLS AND OTHER DATA
Special Skills: List any job-related skills or qualifications that
support your application for this position.
Computer skills: (if applicable to position applying for)

9. Professional licenses, registrations, certifications: (note
expiration dates)
Describe any organizations, memberships, affiliations of which
you are a member.
What (if any) foreign language(s) do you read, write, or speak?
How were these skills acquired?
Please describe any disabilities you have that could affect your
ability to perform this job. If an accommodation is needed,
please indicate.
PROFESSIONAL REFERENCES
List three persons that are professional references (e.g. people
you have worked for or with)
NAME
TITLE/COMPANY NAME
EMAIL ADDRESS
TELEPHONE NO.
( )
( )

10. ( )
Page 6 of 6
Page 3 of 4
Hint: This page contains no intended errors. This is provided
simply because sound application forms contain a disclaimer
and signature page, and to provide you with an example of
typical disclaimer verbiage.
I certify that the answers given herein are true and complete to
the best of my knowledge. I authorize the investigation of all
matters contained in this application and hereby give permission
to contact schools, previous employers, references, and others
in order to verify the facts and information furnished with
regard to my character and qualifications, and hereby release
and indemnify this company from any claims or liability as a
result of such contact. I also hereby release employers, schools,
and other persons from all liability in responding to inquiries in
connection with this application. I understand that
misrepresentations, omissions of facts or incomplete
information requested in this application may remove me from
further consideration for employment. In addition, if employed,
any misrepresentations or omissions of facts called for in this
application will be cause for dismissal at any time without any
previous notice.

11. If I am offered and accept employment with the company, I
understand that my employment is for no specific term and may
be terminated by myself or the employer with or without notice
or cause at any time. I further understand that an oral promise,
policy, custom, business practice or other procedure (including
any employee handbook or any personnel manuals) does not
constitute an employment contract or modification of the at-will
employment relationship between employer and myself.
I understand that the contents of any employee handbook or
personnel manuals are subject to change or modification,
without notice.
Print Name:
Signature:
Date:
This company is an equal employment opportunity employer.
We adhere to a policy of making employment decisions without
regard to race, color, age, sex, religion, national origin,
disability, marital status, or other legally protected classes. We
assure you that your opportunity for employment with us
depends solely upon your qualifications.
Page 4 of 4
Please be very specific when completing all three of these

12. columns/rows!! Stating that something “should not be asked” or
“is illegal” is not specific. To receive full points consideration,
be sure to note the specific legal reason or employment
regulation of concern (in the “Why” middle column).
#
Note/Describe Problematic Item
Why is this problematic?
What would be appropriate in its place, if anything*?
Points
Earned
1
2
3
4
5

13. 6
7
8
9
10
Total Points Earned For Assignment
There are exactly 10 legally problematic areas on this
application form. This assignment is worth 50 points total.
Each complete row above is worth 5 points each. Points
awarded (0-5) per row are based on accuracy of the information
you have provided in each column. Partial points may be
awarded for the row if only part of the answer is correct (for
example the problematic item is noted, but why it is problematic

14. and/or the appropriate replacement verbiage is inaccurate).
*If you borrow verbiage from the text or another source for any
part of your responses above, remember that you MUST use
quotation marks and cite your source appropriately. Information
copied from another source will result in zero points for the
entire answer.
Example of full points answer(for illustration purposes only—
this item is not on the application form above)
#
Note/Describe Problematic Item
Why is this problematic?
What would be appropriate in its place, if anything*?
Points
Earned
“Do you own a car?”
This answer is excellent. It addresses specifically why the item
is problematic (possible Title VII violation) and provides
appropriate replacement verbiage. It is also cited properly to the
text since the wording was taken verbatim. The next example is
also perfectly fine as the answer is in the student’s own words
(no citation required), and still addresses the specifics of the
possible violation and appropriate replacement verbiage.
“Use of credit rating questions tend to have an adverse impact
on minority group applicants and women and has been found
unlawful in some cases. Unless shown to be job-related,
questions on car ownership . . . may violate Title VII”
(Gatewood, Feild, Barrick, 2008, p. 373).
“’Do you have the use of a reliable car?” (if car travel is
required by the job’” (Gatewood, Feild, Barrick, 2008, p. 373).
5

15. The question about car ownership
This can violate Title VII since it can have an adverse impact
on those in a protected class.
We can ask if they have access to a reliable vehicle if it is job
related, meaning driving for the job is required.
5