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APPLICATION FOR EMPLOYMENT

(PRE-EMPLOYMENT QUESTIONAIRE)    (AN EQUAL OPPORTUNITY EMPLOYER)

Personal Information
Name
Last name is required.
First name is required.		 SSN
 
Present address
 
Permanent Address
 
Phone no.
Phone is required.
Invalid phone format. (000)000-0000		 Email
Email is required.Invalid email format.
 
Are you 18 years or older?
 
Are you either a U.S. citizen
or an alien authorized to work in the U.S.?
No
 

Employment desired
Position Date you
can start		 Salary desired
 
Are you employed now?
No
If so, may we inquire of your present employer?
No
 

Education
Name & Location
of School
No. Of Yrs
Attended
Did You
Graduate?
Subjects
Studied
Grammer School
High School
College
Trade,
Business or Correspondence
School
 

General
 
U.S. Military
or Naval Service		 Rank Present Membership
in Nat'l Guard
or Reserves
 
Have you ever been convicted of a crime or pled no contest to a criminal charge?

Please note that answering yes does not automatically disqualify you from employment. The Company will consider each instance on an individual basis.

The age discrimination employment act of 1987 prohibits discrimination on the basis of age respect to individuals who are at least 40 years of age
 

Former Employers

(list below last three employers, starting with last one first)
 
Date (mm/yy)
Name & Address
of Employer
Salary
Position
Reason for Leaving
 
Which of these jobs did you like best?
 
What did you like most about this job?
 

References:

Give the names of three persons not related to you,
whom you have know at least one year.
 
Name
Address
Business
Years Acquainted
 
In case of
emergency, notify:
 

Agreement & Signature
 

by checking this box and adding my digital signature below,

  
 

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

I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause."

  
  Date Digital Signature