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