APPLICATION FOR EMPLOYMENT

PRE-EMPLOYMENT QUESTIONNAIRE
EQUAL OPPORTUNITY EMPLOYER
PERSONAL INFORMATION *DATE:
Required fields*  
NAME (LAST NAME FIRST)
 *SOCIAL SECURITY NO.
 
PRESENT ADDRESS
 CITY
 STATE
 ZIP
PERMANENT ADDRESS
 CITY
 STATE
 ZIP
PHONE NO.
 		REFERRED BY
EMPLOYMENT DESIRED
POSITION
 DATE YOU CAN START
 		 SALARY DESIRED
*ARE YOU EMPLOYED?
 YES NO
 		 *IF SO, MAY WE INQUIRE
OF YOUR PRESENT EMPLOYER?YESNO
 
*HAVE YOU EVER APPLIED TO
THIS COMPANY BEFORE?YESNO		 WHERE?
 WHEN?
 

NAME AND LOCATION OF SCHOOL

YEARS
ATTENDED

DID YOU
GRADUATE?

SUBJECTS
STUDIED
GRAMMAR SCHOOL
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR
CORRESPONDENCE
SCHOOL
GENERAL

SUBJECTS OF SPECIAL STUDY/RESEARCH WORK OR SPECIAL TRAINING/SKILLS
US MILITARY OR NAVAL SERVICE
 RANK
 
FORMER EMPLOYERS
(LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)

DATE
MONTH AND YEAR

NAME AND 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 YEARS KNOWN
1.
2.
3.

Authorization
     "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 AND EMPLOYERS LISTED
ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND MY PERTINENT INFORMATION
THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE THE COMPANY FORM ALL LIABILITY FOR ANY DAMAGE THAT MAY
RESULT FROM UTILIZATION OF SUCH INFORMATION.
     I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY
AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANDY AGREEMENT CONTRARY TO THE
FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED REPRESENTATIVE."

*BY CLICKING "I AGREE", I CERTIFY THAT I HAVE READ AND UNDERSTAND THE ABOVE STATEMENTS,
AND THAT I AGREE WITH THOSE STATEMENTS.

I AGREE    I DON'T AGREE

 

*DATE:

SIGNATURE:________________________________________________________________________________________________________

INTERVIEWED BY: __________________________________________________________________________________________________
Required fields*