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Pre‐Employment Questionnaire
Equal Opportunity Employer
Date: ____________________
www.swagshopjax.com
1775 Erickson Avenue, Harrisonburg, VA 22801 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
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
Application-for-Employment1-2.pdf (PDF, 90.49 KB)
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