Application for Employment

PRE-EMPLOYMENTS QUESTIONNAIRE EQUAL OPPORTUNITY EMPLOYER
Personal Information Date
 
NAME(LAST NAME FIRST)
PRESENT ADDRESS
CITY
STATE
ZIP CODE
PERMANENT ADDRESS
CITY
STATE
ZIP CODE
PHONE NO.
SECONDARY PHONE NO.
REFERRED BY
Employment Desired
POSITION
DATE YOU CAN START
SALARY DESIRED
ARE YOU
EMPLOYED NOW? YesNo
IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYEER? YesNo ARE YOU LEGALLY AUTHORIZED TO WORK IN THIS U.S.? YesNo
EVER APPLIED TO THIS COMPANY BEFORE? YesNo WHERE
WHEN
Education History
NAME &LOCATION OF SCHOOL YEARS ATTENDED DID YOU GRADUATE SUBJECT STUDIED
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL
General Information
SUBJECT OF SPECIAL STUDY/RESEARCH WORK
SPECIAL TRANING
SPECIAL SKILLS
U.S.MILITARY OR NAVAL SERVICES RANK
Former Employers (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)
DATE MONTH AND YEAR NAME & ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO
References (GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.)
NAME ADDRESS BUSINESS YEAR KNOWN
Authorization

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understant that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorized investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they many have, personal or otherwise, and release then company from all liability for any demage that may result from utilization of such information.

I also understant and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, ot to make any aggreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver dose not permit the release or use of disability-releated or medical information in a manner prohibited by the Americans with Disabilites Act (ADA) and other relevant federal and state laws."