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APPLICATION FOR EMPLOYMENT
(Pre-Employment Questionnaire) (An Equal Opportunity Employer)
PERSONAL INFORMATION
SOCIAL SECURITY NUMBER
Date
Name
First
Middle
Last
Present Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Permanent Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
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
POSITION
DATE YOU CAN START
SALARY DESIRED
ARE YOU EMPLOYED NOW?
IF SO MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?
EVER APPLIED TO THIS COMPANY BEFORE?
Where?
When?
REFERRED BY
EDUCATION
GRAMMAR SCHOOL
NAME AND LOCATION OF SCHOOL
NO OF YEARS ATTENDED
DID YOU GRADUATE?
SUBJECTS STUDIED
Add
Remove
HIGH SCHOOL
NAME AND LOCATION OF SCHOOL
NO OF YEARS ATTENDED
DID YOU GRADUATE?
SUBJECTS STUDIED
Add
Remove
COLLEGE
NAME AND LOCATION OF SCHOOL
NO OF YEARS ATTENDED
DID YOU GRADUATE?
SUBJECTS STUDIED
Add
Remove
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL
NAME AND LOCATION OF SCHOOL
NO OF YEARS ATTENDED
DID YOU GRADUATE?
SUBJECTS STUDIED
Add
Remove
GENERAL
SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK
SPECIAL SKILLS
Acclivities: (CIVIC ATHLETIC ETC.)
EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED. SEX. AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.
U. S MILITARY OR NAVAL SERVICE
RANK
PRESENT MEMBERSHIP IN NATIONAL GUARD OR RESERVES
FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST)
DATE MONTH AND YEAR
FROM - TO
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
Add
Remove
FROM - TO
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
Add
Remove
FROM - TO
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
Add
Remove
WHICH OF THESE JOBS DlD YOU LIKE BEST?
WHAT DlD YOU LIKE MOST ABOUT THIS JOB?
REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
NAME
ADDRESS
BUSINESS
YEARS ACQUAINTED
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Remove
THE FOLLOWING STATEMENT APPLIES IN: MARYLAND & MASSACHUSETTS. [Fill in name of state.) IT IS UNLAWFUL IN THE STATE OF ________________________ TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
Signature of Applicant
Max. file size: 64 MB.
IN CASE OF EMERGENCY NOTIFY
NAME
ADDRESS
PHONE NO.
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Remove
Consent
"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 ANY TIME, 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.
Date
MM slash DD slash YYYY
SIGNATURE
Max. file size: 64 MB.
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