Application for Employment
(PRE-EMPLOYMENT QUESTIONAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)

 
Name: 
Full name
 
Date:
Social Security Number:
Present Address:
  Street City State
Zip Code
  
Permanant Address:
  Street City State
Zip Code
  
Phone NO. 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?
Yes No   		Where?   When?  
Referred by:
 
EDUCATION
Name and Location
of School
* NO. of years attended
Did you
graduate?
Subjects Studied
Grammar School
High School
College
Trade, Business, or Correspondence School
 
GENERAL
SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK
Special Skills
Activities (Civic, Athletic, Etc.)
U.S Military or Naval Service
 Rank Present Membership in National Guard or Reserves
FORMER EMPLOYER (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST).
  NAME AND ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING
From/To  
From/To  
From/To  
From/To  
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 KNOWN AT LEAST ONE YEAR
Name
Address
Business
Years Acquainted
1
2
3
THE FOLLOWING STATEMENT APPLIES IN: MARYLAND & MASSSACHUSETTS. (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 LIABILITES.
SIGNATURE OF APPLICANT.
INCASE OF EMERGENCY NOTIFY
NAME ADDRESS PHONE NO.
 

"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSION, 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 NOTICE, AT ANY TIME AT EITHER MY OR THE COMPANY'S OPTION. I ASLO 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 WRITING AND SIGNED BT THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING."
DATE
SIGNATURE
 
 
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