APPLICATION FOR EMPLOYMENT 


(Pre-Employment Questionnaire) (An Equal Opportunity Employer)

 

PERSONAL INFORMATION

Date of This Application:

                                                  Example 01/01/2000

Full Name:   Date of Birth   Social Security:

                                                                                                                                                                                                                                                                       Example 123-45-6789

Present Address: City: State: Zip:


Permanent Address:   City:   State: Zip:

Area Code and Phone No:   Your email address : Are you 18 Years old or older: Yes No

                                                        Example 123-456-7890

 

 

EMPLOYMENT DESIRED

 

Position:   Date You Can Start:   Salary Desired:  

                                                                                                     Example 01/01/2000

 

Are You Employed Now?   If So May We Inquire Of Your Present Employer? 

 

 

Ever Applied To This Company Before?   Where?    When? 

 

 

Referred By   

 

 

EDUCATION

 

 

Grammar School Name and Location of School *No. of Years Attended

*Did You Graduate?

Subject Studied
High School

College

Trade, Business or Correspondence School

 

                                                                                                  

GENERAL

Subjects of Special Study or Research Work

 

Special Skills

 

Activities: (Civic, Athletic, etc.)

  Exclude Organizations, The Names of which indicates the race, creed, sex, age, marital status, color or nation of origin of it members

U.S. Military or Naval Service

Rank

Present Membership in National Guard or Reserves

*The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age. 

 

 

FORMER EMPLOYERS (List Below Last Three Employers, Starting with Last One First).

 

Date Month and Year

 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 & Massachusetts. (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 liability.

 

In Case of Emergency Notify

Name

Address

Phone No.

 

 

"I Certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I Authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you. I Understand and Agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause."

Date:

         Example 01/01/2000

 Signature: