Papa's Application for Employment
Pre-employment Questionnaire
Equal Opportunity Employer
Personal Information
Last Name *
Your answer
First Name *
Your answer
Email Address *
Your answer
Present Address *
street, city, state, zip code
Your answer
Permanent Address
leave blank if same as Present Address
Your answer
Social Security Number *
Your answer
Phone No. *
Your answer
Secondary Phone No. *
Your answer
Referred By
Your answer
Employment Desired
Position
Your answer
Are you employed now? *
If so, may we inquire of your present employer? *
Date You Can Start *
MM
/
DD
/
YYYY
Salary Desired
Your answer
Education History
High School *
include name/location of school, years attended, whether you graduated or not, subjects studied
Your answer
College
include name/location of school, years attended, whether you graduated or not, subjects studied
Your answer
Trade, Business, or Correspondence School
include name/location of school, years attended, whether you graduated or not, subjects studied
Your answer
General Information
Subject of special study/research work
Your answer
Special Training
Your answer
Special Skills
Your answer
U.S. military or naval service
Your answer
Former Employers
List below the last four employers, starting with last one first.
EMPLOYER 1
From
MM
/
DD
/
YYYY
To
MM
/
DD
/
YYYY
Name & Address of Employer
Your answer
Salary
Your answer
Position
Your answer
Reason for leaving
Your answer
EMPLOYER 2
From
MM
/
DD
/
YYYY
To
MM
/
DD
/
YYYY
Name & Address of Employer
Your answer
Salary
Your answer
Position
Your answer
Reason for leaving
Your answer
EMPLOYER 3
From
MM
/
DD
/
YYYY
To
MM
/
DD
/
YYYY
Name & Address of Employer
Your answer
Salary
Your answer
Position
Your answer
Reason for leaving
Your answer
EMPLOYER 4
From
MM
/
DD
/
YYYY
To
MM
/
DD
/
YYYY
Name & Address of Employer
Your answer
Salary
Your answer
Position
Your answer
Reason for leaving
Your answer
References
Give below the names of three persons not related to you, whom you have known at least one year.
REFERENCE 1
Name
Your answer
Address
Your answer
Business
Your answer
Years Known
Your answer
REFERENCE 2
Name
Your answer
Address
Your answer
Business
Your answer
Years Known
Your answer
REFERENCE 3
Name
Your answer
Address
Your answer
Business
Your answer
Years Known
Your answer
Authorization
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 and 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 disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

I understand that a consumer credit report or criminal record check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

Signature *
type your full name in ALL CAPS
Your answer
SUBMIT YOUR APPLICATION
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