Ban the Box Compliant Job Application Template

Employers must take into account current federal, state, and local laws which include “Ban the Box” and Fair Chance laws. Applications for employment should not have conviction checkboxes.

Here is a sample template with compliant language:

Application for Employment

Applicant Information

• Full legal name:

• Other names used, if needed to verify education or employment records:

• Current address:

• City/State/ZIP:

• Phone number:

• Email:

• Preferred method of contact:

Position Information

• Date available to start:

• Desired schedule: Full-time / Part-time / Temporary / Seasonal

• Desired pay range:

Education

• High school or equivalent school name and location:

• Diploma, GED, or certificate earned:

• College, trade school, or other training:

• Degree, certificate, license, or coursework:

• Professional licenses and certifications:

List any current license, certification, registration, or special training relevant to the position. Do not include information that is not job-related.

Employment History

Employer 1

• Employer name:

• Job title:

• Dates worked:

• Supervisor name and title:

• Phone or email:

• Duties and accomplishments:

• Reason for leaving:

Employer 2

• Employer name:

• Job title:

• Dates worked:

• Supervisor name and title:

• Phone or email:

• Duties and accomplishments:

• Reason for leaving:

Work Authorization and Job Requirements

1. Are you legally authorized to work in the United States? Yes / No

2. Will you now or in the future require employer sponsorship for employment visa status? Yes / No

3. Can you perform the essential functions of the position, with or without reasonable accommodation? Yes / No

References

Please provide professional references.

Reference 1

• Name:

• Relationship:

• Company:

• Phone:

• Email:

• Reference 2

  • Name:

  • Relationship:

  • Company:

  • Phone:

  • Email:

Applicant Certification

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation may result in removal from consideration or, if hired, termination of employment, subject to applicable law.

Applicant signature:

Date:

Download Example Templates

Download this template: To save a copy of this “Ban the Box” employment application sample template, select File > Download from your browser menu. You can download this document in Microsoft Word (.docx) or PDF (.pdf).

Pro-Tip: Remember adding a company logo and specific contact information to the header will further enhance a professional brand image.

Get Legal Help

Laws change quickly. You may want your in-house counsel or an employment attorney to review your employment application to make sure it complies with local, state, and federal laws.

Disclaimer: The information presented here does not constitute legal advice or representation. It is general and educational in nature, may not reflect all recent legal developments, and may not apply to your unique facts and circumstances. Consider consulting with a qualified attorney if you have legal questions.