APPLICATION  FOR  EMPLOYMENT
PRE-EMPLOYMENT
QUESTIONNAIRE
AN EQUAL
OPPORTUNITY EMPLOYER
PERSONAL  INFORMATION
NAME (LAST NAME, FIRST)
* 		SOCIAL SECURITY NO.
PRESENT ADDRESS
*
APT. NO.
 CITY
*
STATE
*
ZIP
*

ARE YOU 18 YEARS OR OLDER?
 YES     NO

 PHONE
*
DO YOU HAVE A VALID MICHIGAN DRIVER'S LICENSE?
 YES     NO
EMAIL ADDRESS
*

 

DESIRED  EMPLOYMENT
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 		 WHEN?
EVER WORKED FOR THIS COMPANY BEFORE?
 YES    NO 		 WHEN?
REASON FOR LEAVING
    
WHO REFERRED YOU TO THIS COMPANY?    
EMPLOYMENT AGENCY
NEWSPAPER ADVERTISING
FRIEND
STATE EMPLOYMENT OFFICE
COLLEGE PLACEMENT SERVICE
WALK-IN
OTHER

 

EDUCATION
SCHOOL LEVEL
NAME AND LOCATION OF SCHOOL
NO. OF YEARS
ATTENDED
DID YOU
GRADUATE?
SUBJECTS STUDIED
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL

 

GENERAL
SPECIAL TRAINING
SPECIAL SKILLS

 

FORMER EMPLOYERS
LIST BELOW LAST THREE EMPLOYERS, STARTING WITH THE MOST RECENT ONE FIRST.
NAME OF PRESENT OR LAST EMPLOYER
ADDRESS
 CITY

 STATE

ZIP
STARTING DATE
 LEAVING DATE
 JOB TITLE
WEEKLY STARTING SALARY
 WEEKLY FINAL SALARY
 MAY WE CONTACT YOUR SUPERVISOR?
      YES    NO 
NAME OF SUPERVISOR
 TITLE
 PHONE
DESCRIPTION OF WORK
REASON FOR LEAVING

 

NAME OF PRESENT OR LAST EMPLOYER
ADDRESS
 CITY

 STATE

ZIP
STARTING DATE
 LEAVING DATE
 JOB TITLE
WEEKLY STARTING SALARY
 WEEKLY FINAL SALARY
 MAY WE CONTACT YOUR SUPERVISOR?
      YES    NO 
NAME OF SUPERVISOR
 TITLE
 PHONE
DESCRIPTION OF WORK
REASON FOR LEAVING

 

NAME OF PRESENT OR LAST EMPLOYER
ADDRESS
 CITY

 STATE

ZIP
STARTING DATE
 LEAVING DATE
 JOB TITLE
WEEKLY STARTING SALARY
 WEEKLY FINAL SALARY
 MAY WE CONTACT YOUR SUPERVISOR?
      YES    NO 
NAME OF SUPERVISOR
 TITLE
 PHONE
DESCRIPTION OF WORK
REASON FOR LEAVING

 

REFERENCES
BELOW, GIVE THE NAMES OF THREE PERSONS YOU ARE NOT RELATED TO, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR
 
NAME
ADDRESS
BUSINESS
YEARS
ACQUAINTED
1
2
3

 

HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 5 YEARS?           YES    NO
IF YES, EXPLAIN (WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION)

 

AUTHORIZATION (Box must be checked to be valid)

 

"BY CHECKING THIS BOX, 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 DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.

I ALSO UNDERSTAND AND AGREE THT 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 AN AUTHORIZED COMPANY REPRESENTATIVE."

DATE
* 		NAME
*

* REQUIRED FIELDS

           

TAKE ME BACK TO THE MAIN PAGE