PRE-EMPLOYMENT QUESTIONNAIRE

EQUAL OPPORTUNITY EMPLOYER


Position Applying for:

Personal Information

Last Name: 
First Name: 
City: 
Phone Number: 


Education History

Did you graduate high school?  YesNo
Did you attend college?YesNo
Did you attend a trade or correspondence school?YesNo
Do you have any special skills or training accquired outside of college or trade schools?  YesNo

Former Employers

Employer 1

Name of Employer:      From:     To: 
Street Address: 
City: 
State: 
Zip Code: 
Supervisor: 
Phone #: 
Job Title:
Duties and Resposibilities
Reason for leaving? 

Employer 2

Name of Employer:      From:     To: 
Street Address: 
City: 
State: 
Zip Code: 
Supervisor: 
Phone #: 
Job Title:
Duties and Resposibilities
Reason for leaving? 

Employer 3

Name of Employer:      From:     To: 
Street Address: 
City: 
State: 
Zip Code: 
Supervisor: 
Phone #: 
Job Title:
Duties and Resposibilities
Reason for leaving? 

Other Information

Have you ever served in the U.S. armed forces?  YesNo

Are you a U.S. citizen?  YesNo

Have you been convicted of a felony or misdemeanor within the last five year?  YesNo

Please list any languages that you speak, other than English, and whether or not you can read or write them as well: 

  

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