Application for Employment

PRE-EMPLOYMENT QUESTIONNAIRE EQUAL OPPORTUNITY EMPLOYER

Personal Information

Employment Desired

YESNO
YESNO
YESNO

Education History

 NAME & LOCATION OF SCHOOLYEARS ATTENDEDDID YOU GRADUATESUBJECTS STUDIED
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL

General Information

Former Employers

DATE MONTH/YEARNAME & ADDRESS OF EMPLOYERSALARYPOSITIONREASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO

References

NAMEADDRESSBUSINESSYEARS KNOWN

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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 any pertinent information they may have, personal or otherwise, and release the company from 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 any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disability Act (ADA) and other relevant federal and states laws.

I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that in compliance with federal law, the company will provide me with a written notice regarding the use of these history or convistion will not automatically result in disqualification from employment."

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.