APPLICATION FOR EMPLOYMENT

(Pre-Employment Questionnaire) (An Equal Opportunity Employer)

Fields with an asterisk (*) are required. Social Security Number

Invalid Input
Last Name (*)

Invalid Input
First Name (*)

Invalid Input
Middle Name

Invalid Input

PRESENT ADDRESS

Street
Invalid Input
City
Invalid Input
State
Invalid Input
Zip
Invalid Input

PERMANENT ADDRESS

Street
Invalid Input
City
Invalid Input
State
Invalid Input
Zip
Invalid Input
Phone # (*)

Invalid Input
Email Address (*)

Invalid Input
Are you 18 years or older
Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

EMPLOYMENT DESIRED

Position
Date You Can Start
Salary Desired
Are you employed now?
If so, may we inquire of your present employer
Ever applied to this company before?
If so, where?
When?
Referred By

EDUCATION

Name and Location of School **Years
Attended
**Did You Graduate? Subjects Studied
Grammar School

High School

College

Trade, Business,
or Corres-
pondence School


GENERAL

Subjects of special study or research work

Special Skills

Activities (Civic, Athletic, etc)

Exclude organizations, the name of which indicates the race, creed. sex. age, marital status, color or nation of origin of its members.

U.S. Military or Naval Service
Rank

Present Membership in National Guard or Reserves

FORMER EMPLOYERS (starting with the most recent)

Date (Month and Year) Name and Address of Employer Reason for Leaving
From
To
Salary

Position
From
To
Salary

Position
From
To
Salary

Position
From
To
Salary

Position

Which of these jobs did you like best?

What did you like most about this job?

REFERENCES

(Give the names of three persons not related to you, whom you have known at least one year)

Name Address Business Years Acquainted

IN CASE OF EMERGENCY, NOTIFY:

Name
Address
Phone #

"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED. MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE. AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING."

Date (*)

Invalid Input
Electronic Signature (type your name) *

Please Type your Name

This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment Form is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.

**This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26. 1991.


Refresh
Invalid Input