APPLICATION Blank .pdf

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Original filename: APPLICATION Blank.pdf
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APPLICATION FOR EMPLOYMENT

PRE-EMPLOYMENT QUESTIONAIRE
EQUAL OPPORTUNITY EMPLOYER

PERSONAL INFORMATION:

DATE:

Name (Last, First, Middle)

Social Security Number:

Present address (Street, City, State, Zip)
Phone number:

Referred by:

EMPLOYMENT DESIRED:
Date you can start:

Position:
Are you currently employed?

YES

Ever applied to this company before? YES

Salary desired:

NO If so, May we inquire of your present employer? YES
NO

Where?

When?

EDUCATION:
SCHOOL

NAME AND LOCATION

GRADUATED
Yes

MAJOR SUBJECTS

No

HIGH SCHOOL

CONTINUING
EDUCATION
COLLEGE
OTHER

OTHER INFORMATION:
Special Training/Courses:

Special Skills for This Employment:

Activities and Interests:

EXCLUDE ORGANIZATIONS, THE NAME OR CHARACTER OF WHICH INDICATES THE RACE, CREED, SEX, MARITAL STATUS, AGE, COLOR, OR
NATIONAL ORIGIN OF ITS MEMEBERS.

NO

CURRENT AND FORMER EMPLOYERS:
DATES
FROM:
______________
TO:

(LIST MOST RECENT EMPLOYMENT FIRST)
WAGES
POSITION
REASON FOR
LEAVING
$
_________________________________________
PER:

NAME AND ADDRESS OF EMPLOYER

$

FROM:
______________
TO:

_________________________________________

FROM:
______________
TO:

_________________________________________

PER:
$
PER:

REFERENCES: (GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU)
NAME
ADDRESS & PHONE
BUSINESS

YEARS
KNOWN

INCASE OF EMERGENCY, NOTIFY:
NAME

ADDRESS

PHONE

I authorize investigation of all statements contained in this application, I understand that misrepresentation or
omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for
no definite period and may, at the discretion of the employer, be terminated at any time without any previous
notice.

SIGNED: _________________________________________

DATE: _____________________

APPLICANT – DO NOT WRITE BELOW THIS LINE
Interviewed By:
Remarks:
Neatness:
Ability:
Hired:
Start Date:
Approvals:
___________________
1.) Employment Manager

Dept:

Position:
Salary:
_________________
2.) Employment Head

________________
3.) General Manager


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