Application for Employment1 2 .pdf

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Original filename: Application-for-Employment1-2.pdf
Title: Microsoft Word - Employment Application
Author: lcoaker

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Pre‐Employment Questionnaire 
Equal Opportunity Employer 
 
Date: ____________________ 
 
 
www.swagshopjax.com
1775 Erickson Avenue, Harrisonburg, VA 22801 Œ www.maysupply.com 
6733 103rd St Suite 5 Jacksonville,
FL 32210 5441 Norwood Ave Jacksonville, FL 32208
 
Personal Information 
Name (Last, First) 
Present Address 

City

State

Zip Code 

Permanent Address 

City

State

Zip Code 

Phone Number 

Cell Phone 

Email

Referred by 

 
Employment Desired 
Position desired 

Date available to start

Are you currently employed? 
     † Yes     † No 

Salary desired 
If so, may be contact your present employer? 
     † Yes     † No 

Have you ever applied to this company before? 
     † Yes     † No 

Is so, for what position?

When? 

 
Education 
 

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 your last four employers below, beginning with the most recent) 
Date, Month, Year 
From 
To 
From 
To 
From 
To 
From 
To 

Name & address of 
employer 
 

Salary 

Position 

Reason for leaving 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been convicted of any violation(s) of the law, (including moving violations)? 
     † Yes     † No 
 

If yes, please explain:  

Have you ever been convicted of a felony? 
     † Yes     † No 
 

If yes, please explain:  

 
References 
Please list the names of three persons not related to you that you have known for at least one year. 
Name 

Address 

Business 

Phone 

Years Known 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Authorization 
 
I certify that the facts contained in this application are true and complete to the best of my knowledge and understanding 
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 an damage that may result from utilization of such information.  I also authorize May Supply  
Company, in the regular course of business, and depending upon certain positions and circumstances, to obtain a personal credit 
report, criminal background check, driving record and/or drug and alcohol screening test as they deem necessary.  I understand that 
May Supply pledges to handle this information in a manner that will protect the privacy rights of its applicants. 
I understand that this application is not an employment guarantee or contract.  All employment offers will be made in 
writing. 

 
Date: _____________________          Signature: ______________________________________ 
 
Interviewed by: ___________________________________         Date: _____________________           
 
 
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Do Not Write Below This Line  ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 

Remarks 
 
 
 
 
 
 
 
 
 
Neatness 

Character

Personality 

Ability

Hired 

 

For dept. 

Position

Will Report

Salary


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