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PRE-EMPLOYMENT QUESTIONNAIRE | EQUAL OPPORTUNITY EMPLOYER
PERSONAL INFORMATION DATE
FIRST NAME
SOCIAL SECURITY NO.
LAST NAME
MIDDLE INITIAL
PHONE NUMBER
STREET ADDRESS
CITY ST
ZIP CODE
REFERRED BY
______________________________________________________________________________________________________________________________________________
EMPLOYMENT DESIRED
POSITION
DATE YOU CAN START
DESIRED SALARY
ARE YOU CURRENTLY EMPLOYED?
IF YES, MAY WE CONTACT YOUR CURRENT EMPLOYER?
HAVE YOU EVER APPLIED/WORKED FOR EMPLOYMENT WITH GARDEN STREET IRON & METAL?
WHERE?
WHEN?
______________________________________________________________________________________________________________________________________________
EDUCATION HISTORY
Please select highest level of education completed and complete fields with corroborating information.
SCHOOL NAME
ADDRESS ST ZIP CODE
DID YOU GRADUATE?
YEARS ATTENDED
MAJOR
______________________________________________________________________________________________________________________________________________
MILITARY HISTORY
WORK OR SPECIAL TRAINING/SKILLS
U.S. MILITARY OR NAVAL SERVICE
RANK
______________________________________________________________________________________________________________________________________________
EMPLOYMENT HISTORY
BEGIN WITH MOST RECENT EMPLOYER
FORM EMPLOYER NAME
YEAR
END DATE
YEAR
POSITION
REASON FOR LEAVING
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FORM EMPLOYER NAME
YEAR
END DATE
YEAR
POSITION
REASON FOR LEAVING
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BEGIN WITH MOST RECENT EMPLOYER
FORM EMPLOYER NAME
YEAR
END DATE
YEAR
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 CITY
ZIP CODE
PHONE NUMBER
YEARS KNOWN
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NAME
ADDRESS CITY
ZIP CODE
PHONE NUMBER
YEARS KNOWN
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NAME
ADDRESS CITY
ZIP CODE
PHONE NUMBER
YEARS KNOWN
______________________________________________________________________________________________________________________________________________
AUTHORIZATION
"I certify that the facts contained in this appication are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be rounds for dimissal.
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 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 an authorized company representative.
This waiver does not permit the release or use of disabiity-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws".
CHECK YES IF YOU AGREE TO THE TERMS ABOVE
YES I AGREE
NO I DO NOT AGREE
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