Application-For-Employment

Application For Employment

(Pre-Employment Questionnaire)(An Equal Opportunity Employer)

PERSONAL INFORMATION

Are you 18 years or older?

Yes No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

Yes No

EMPLOYMENT DESIRED

Date you can start

Are you employed now?

Yes No

May we inquire of your present employer?

Yes No

Ever applied to this company before?

Yes No

EDUCATION

School

Number of years attended

Did You Graduate?

Subjects Studied

School

Number of years attended

Did You Graduate?

Subjects Studied

School

Number of years attended

Did You Graduate?

Subjects Studied

Trade, Business or Correspondence School

Number of years attended

Did You Graduate?

Subjects Studied

GENERAL

Subjects of special study or research work

Special Skills

Activities: (Civic, Athletic, Etc.)

US Military Service?

Yes No

Rank At Discharge

Present membership in National Guard or Reserves

Yes No

REFERENCES

Give the names of three persons not related to you, whom you have known at least one year.

Name and Occupation

Address

Phone Number

Years Acquainted

FORMER EMPLOYERS

(LIST BELOW PREVIOUS EMPLOYERS, STARTING WITH MOST CURRENT EMPLOYER).

Work History 1

Name and Address of Company and Type of Business

Date From

Date To

Salary

Describe in detail the work you did / Position

Reason For Leaving

Work History 2

Name and Address of Company and Type of Business

Date From

Date To

Salary

Describe in detail the work you did / Position

Reason For Leaving

Work History 3

Name and Address of Company and Type of Business

Date From

Date To

Salary

Describe in detail the work you did / Position

Reason For Leaving

Work History 4

Name and Address of Company and Type of Business

Date From

Date To

Salary

Describe in detail the work you did / Position

Reason For Leaving

IN CASE OF EMERGENCY NOTIFY

I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANYTIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME,OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.

*This form has been revised to comply with the provisions of the Americans with Disabilities Act