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APPLICATION FOR EMPLOYMENT

(PRE-EMPLOYMENT QUESTIONAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)


PERSONAL INFORMATION


Last Name First Name

Present Address: Street City State Zip Code

Permanent Address: Street City State Zip Code

Phone No. Are you 18
years of age
or older? 		Yes No


EMPLOYMENT DESIRED


Position Date you can Start Salary Desired

Are you employed now? Yes No If so, may we inquire of your present employer? Yes No

Ever applied to this company before? Yes No Where? When?

Referred by:


EDUCATION

 Name and Location of School *No of Years Attended *Did you Graduate? Subjects Studied
Grammar School Yes No
High School Yes No
College Yes No
Trade, Business, or Correspondence School Yes No


GENERAL


Subjects of Special Study or Research Work

Special Skills

Activities(Civic,Athletic, Etc.) Exclude organizations, the name of which indicates the race,creed, sex, age, marital status color or nation of origin of its members.


U.S. Military or Naval Service Rank Present Membership in National Guard or Reserves Yes No


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

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 for at least one year.

NAME ADDRESS BUSINESS YEARS ACQUAINTED
1.
2.
3.



In case of emergency notify: NAME: ADDRESS: PHONE NUMBER:


By submitting this form, "I certify that all the information submitted by me on this application is true and complete,and i understand that any false information, ommisions, or misrepresentations are discovered, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, at any time, at either my or the company's option. I also understand and agree that the terms and conditions 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 it's president, and then only when in writing 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."

Do you accept this agreement? Yes No