Pre-Employment Questionaire Equal Opportunity Employer

First Name M.I. Last Name

Address City State

Zip Code

Phone No.

Who referred you?

Employment Desired

Position

What date can you start.

What salary are you expecting

Are you currently employed? Yes No

If so, May we inquire of your present employer? Yes No

Have you applyed to this company before? Yes No
If yes. Where and When

Education History

Grammer School Name & Location

High School Name & Location

Did you graduate? Yes No

What years did you attend High School?

College Name & Location

Years Attended

Did you graduate? Yes No

What subjects did you study?

Trade, Business or Correspondence School | Name and Location

Years Attended

Did you graduate? Yes No

What Subjects did you study?

General Information

Subjects of Special Study / Research Work or Special Training / Skills

Military Service

Branch

Rank

Former Employers (list below the last four employers, starting with last one first)

Most recent Employer

Employer Name & Address

Date Hired & Date Left -

What was your salary?

What was your position?

Reason for leaving

Former Employer

Employer Name & Address

Date Hired & Date Left -

What was your salary?

What was your position?

Reason for leaving

Former Employer

Employer Name & Address

Date Hired & Date Left -

What was your salary?

What was your position?

Reason for leaving

Former Employer

Employer Name & Address

Date Hired & Date Left -

What was your salary?

What was your position?

Reason for leaving

References
Give below the names of three persons not related to you, whom you have known at least one year.

Name

Address

Business

Years known


Name

Address

Business

Years known


Name

Address

Business

Years known

Authorizaztion:
"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 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 any that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by authorized company representative. This waver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

By submitting this form to Absolute Staffing I am electroniclly signing this agreement "

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