Pre-Employment Questionnaire


(An Equal Opportunity Employer)

CONTACT INFORMATION

Date
Last Name
Name
Middle

Address

Street
City
State
Zip
Email
Phone

Desired Position

Are you prevented from lawfully becoming employed in this country because of a visa or immigration status?
DESIRED POSITION
FL D LICENSE
FL G LICENSE
Are you employed now?
If so, may we contact your present employer?

Ever applied to this company before?

Where?

When?
Refered by

Education

Education Name and location of school Years attended Did you graduate Subjects studied
Grammar School
High School
College
Trade, business of correspondence school

Criminal History:

Have you ever been convicted of a crime?



MILITARY SERVICE:


Country:
Branch:
Rank:
National guard or reserves:
EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.
Special Skills:
Activities: (Civic, athletic, etc.)

FORMER EMPLOYERS (List your last three employers, starting with last one first).

Month & Year Name and Address of employer Salary Position Reason for leaving



REFERENCES (Names of three individuals [Not Related to you] whom you have known at least one year).

# NAME PHONE E-MAIL YEARS ACQUAINTED
1
2
3
In case of emergency notify:


Name:
Relationship:
Phone:

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, and compensation, can be terminated, with or without cause. And with notice at any time, at either my or the company’s option. Also I understand and agree that the terms and condition 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 its 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.

Signature: