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Application For
Employment |
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(Pre-Employment
Questionnaire) (An Equal Opportunity Employer) |
| We
consider applicants for all positions without regard to race, color,
religion, sex, sexual orientation, national origin, age, marital or
veteran status, the presence of a non-job-related medical condition
or disability, or any other legally protected
status. |
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| General Information |
| Position Applying for: |
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| First Name: |
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| Middle Name: |
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| Last Name: |
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| Address: |
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| City: |
State: Zip: |
| Phone Number(s): ( )--
(
)-- |
| Drivers License Number:
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| Do you have a Commercial Drivers
License? Yes
No |
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| Have you ever filed an application
with us before? Yes No |
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If yes, give date: /
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| Have you ever been employed with
us before?
Yes
No |
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If yes, give dates:
/
to /
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| Are you currently employed?
Yes
No |
| May we contact your present
employer? Yes No |
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Are
you prevented from lawfully becoming employed in this country
because of Visa or Immigration Status? Proof of
citizenship or immigration status will be required upon
employment Yes No |
| On which Date will you be
available for work?
, |
| Are you available for work:
Full Time
Part Time
Shift Work
Temporary |
| Are you currently on "lay-off"
status and subject to recall? Yes No |
| Can you travel if a job requires
it?
Yes No |
| Have you been convicted of a
felony within the last 7 years?
Yes No |
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Conviction will not necessarily disqualify an applicant from
employment |
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If Yes, Please explain:
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Do you have any
physical limitations that preclude you from performing any work for
which you are being considered? Yes
No |
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If Yes, what can be done to
accommodate your limitation?
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| Have you been in the U.S. Military
or Naval Service? Yes No |
| Present membership in National
Guard or Reserves? Yes No |
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References |
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Give the address and telephone number
of three references who are not related to you and are not previous
employers. |
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| Education |
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High School: |
School Name: City: |
| Years Attended: Graduate? Yes
No |
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Undergraduate College/
University: |
School Name: City: |
| Subject (s) Studied: |
| Years Attended: Graduate? Yes
No |
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Graduate/ Professional: |
School Name: City: |
| Subject (s) Studied: |
| Years Attended: Graduate? Yes No |
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| Describe any specialized training
apprenticeship skills and extra-curricular activities:
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| Describe any honors you have
received:
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| State any additional information
you fell may be helpful to us in considering your application:
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| Summarize special job-related
skills and qualifications acquired from employment or other
experience:
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| Employment Experience |
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Start with your present or most
recent job. |
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By clicking the Submit button:
I certify that answers given
herein are true and complete to the best of my knowledge.
I authorize investigation of
all statements contained in this application for employment as may
be necessary in arriving at an employment decision.
This application for
employment shall be considered active for a period of time not to
exceed 45 days. Any applicant wishing to be considered for
employment beyond this period should inquire as to whether or not
applications are being accepted at that time.
I hereby understand and
acknowledge that, unless otherwise defined by applicable law, any
employment relationship with this organization is of an "at will"
nature, which means that the Employee may resign at any time and the
Employer may discharge Employee at any time with or without
cause. It is further understood that this "at will" employment
relationship may not be changed by any written document or by
conduct unless such charge is specifically acknowledged in
writing by an authorized executive of this
organization.
In the event of employment, I
understand that false or misleading information given in my
application or interview(s) may result in discharge. I
understand, also, that I am required to abide by all rules and
regulations of the employer. |
