Job Applicant Questionnaire And Agreement Template (Page 2 of 4) in pdf

EMPLOYMENT HISTORY: (start with most recent employer) (if providing a resume, do not complete)

Company ___________________________________________________ Job Title _____________________________

Address ________________________________________________ City ___________________________ State _____

Salary / Wage _____________ per _____________ Dates Worked: From _______________ To ______________

Still Employed? [ ] Yes [ ] No

Supervisor __________________________ Telephone _____________________

Reason for leaving __________________________________________________________________________________

Reference Check Performed By _________________________________

Company ___________________________________________________ Job Title _____________________________

Address ________________________________________________ City ___________________________ State _____

Salary / Wage _____________ per _____________ Dates Worked: From _______________ To ______________

Still Employed? [ ] Yes [ ] No

Supervisor __________________________ Telephone _____________________

Reason for leaving __________________________________________________________________________________

Reference Check Performed By _________________________________

Company ___________________________________________________ Job Title _____________________________

Address ________________________________________________ City ___________________________ State _____

Salary / Wage _____________ per _____________ Dates Worked: From _______________ To ______________

Still Employed? [ ] Yes [ ] No

Supervisor __________________________ Telephone _____________________

Reason for leaving __________________________________________________________________________________

Reference Check Performed By _________________________________

*DURING THE LAST 7 YEARS, HAVE YOU EVER BEEN CONVICTED OF, PLED GUILTY TO OR PLED NO CONTEST TO

A CRIME, EXCLUDING MISDEMEANORS AND TRAFFIC VIOLATIONS? [ ] Yes [ ] No

IF YES, DESCRIBE: ____________________________________________________________________________

______________________________________________________________________________________________

* A conviction will not necessarily bar you from employment. Also, see applicable state restrictions below.

MILITARY SERVICE:

Branch __________________________ Date [ Entered ____________ Discharged ___________ ] RANK _____________

Do you have service-related skills applicable to civilian employment? [ ] Yes [ ] No

If Yes, describe: ______________________________________________________________________________________

____________________________________________________________________________________________________

PERSONAL REFERENCE (not a family member):

Name: _______________________________

Phone:_________________

Relation:_____________________

ADDITIONAL INFORMATION: (all applicants)

List additional training or experience ______________________________________________________________________

____________________________________________________________________________________

Describe in detail your activities, hobbies and interests _______________________________________________________

____________________________________________________________________________________

List any other personal characteristics that would make this a suitable position for you________________________________

____________________________________________________________________________________

Job Applicant Questionnaire And Agreement Template Page 2