Pre-Employment Questionnaire

Personal Information

*Last Name: 
*First Name:  
Middle Name:  
Present Address: 
 
City: 
State: 
Zip Code: 
Permanent Address: 
 
City: 
State: 
Zip Code: 
Phone Number: 
*Email: 

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?
Yes
No

Are you 18 years or older?
Yes
No


Employment Desired

Position: 
Date you can start: 
Salary desired: 
Are you employed now?:  Yes No
If so may we inquire of your present employer?:  Yes No
Have you ever applied to this company before?:  Yes No
Where?: 
When?: 
Referred by: 


Education

Grammar School / Location:  # of years attended: 
High School / Location:  # of years attended:  Did you graduate? 
Yes    No
College / Location:  # of years attended:  Did you graduate? 
Yes    No
Subjects studied: 
Trade/Business/Correspondence School / Location:  # of years attended:  Did you graduate? 
Yes    No
Subjects studied: 
Military or Naval Service:  Rank:  Present membership in National Guard or Reserves? 
Yes    No


General

Activities: (Civil, Athletic, Ect.) 
(Exclude organizations of which indicate race, gender, creed, sex, age, marital status, color, or nation of origin of its members.)
Have you ever been convicted of a felony? Yes No
Have you ever been convicted of a sex crime? Yes No


Month & Year Name & Address of Employer Salary Position Reason for Leaving
Which of these jobs do/did you like best?
What did you like most about this job?


References: Give the names of three people not related to you, whom you have known at least one year.
Name Address Business Years Acquainted


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