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APPLICATION FOR EMPLOYMENT

PRE-EMPLOYMENT QUESTIONNAIRE
EQUAL OPPORTUNITY EMPLOYER

 
PERSONAL & EMPLOYMENT INFORMATION
 
* NAME (LAST NAME FIRST):  
* SOCIAL SECURITY #:  

* Have you had any name changes this employer should know about in order to verify job or education history?
Yes
No

If Yes, Previous Name:
* PRESENT ADDRESS:  
* CITY:  
* STATE:  
* ZIP:  
PERMANENT ADDRESS:
CITY:
STATE:
ZIP:
* PHONE:  
* EMAIL:  
REFERRED BY:
* ARE YOU APPLYING FOR:  
Full Time
Part Time Summer Only
Days Only
Nights Only
Days/Nights
* POSITION:  
* DATE YOU CAN START:  
* ARE YOU 18 YEARS OR OLDER?   Yes
No

If not over 18 what is your date of birth?

* ARE YOU WILLING TO WORK:   WEEKENDS
HOLIDAYS
OVERTIME

* DO YOU HAVE RELIABLE TRANSPORTATION TO AND FROM WORK?
Yes
No

* DO YOU NEED ANY SPECIFIC TIME OFF OF WORK?

* HAVE YOU EVER WORKED FOR:  
Pumphouse Pizza & Brewing Co.
Great/Black Wolf Lodge
Houlihan's
Noah's Ark
Copa Cabana
Moosejaw Pizza & Brewing Co.
None
IF YES, WHEN?
* SALARY DESIRED:  
* HOW WERE YOU REFFERED TO US?  
* ARE YOU EMPLOYED?   Yes
No

* IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?
Yes
No

* EVER APPLIED TO THIS COMPANY BEFORE?   Yes
No
WHEN?
WHERE?

* ARE YOU CURRENTLY AUTHORIZED TO WORK IN THE UNITED STATES FOR ANY EMPLOYER?
Yes
No

* Functions of this job include stretching, sitting/standing for long periods & lifting 50 lbs. Is there any reason you cannot perform these duties?
Yes
No

If Yes, Please describe any thing we might do to make it possible for you to perform these job duties.

* HAVE YOU BEEN CONFICTED OF A CRIME? (do not include convictions where the records have been expunge.)
Yes
No

IF YES, PLEASE IDENTIFY THE CRIME(S) FOR WHICH YOU WERE CONVICTED, DATE, STATE & COUNTY:

 
EDUCATION HISTORY
 
 

GRAMMAR SCHOOL
 
* NAME & LOCATION OF SCHOOL:  
* YEARS ATTENDED:  
* DID YOU GRADUATE?   Yes
No
* SUBJECTS STUDIED:  
 

HIGH SCHOOL:
 
* NAME & LOCATION OF SCHOOL:  
* YEARS ATTENDED:  
* DID YOU GRADUATE?   Yes
No
* SUBJECTS STUDIED:  
 

COLLEGE:
 
NAME & LOCATION OF SCHOOL:
YEARS ATTENDED:
DID YOU GRADUATE? Yes
No
SUBJECTS STUDIED:
 

TRADE SCHOOL:
 
NAME & LOCATION OF SCHOOL:
YEARS ATTENDED:
DID YOU GRADUATE? Yes
No
SUBJECTS STUDIED:
 
GENERAL INFORMATION
 

SUBJECTS OF SPECIAL STUDY/RESEARCH WORK OR SPECIAL SKILLS:

US MILITARY OR NAVAL SERVICE:
RANK:
 
FORMER EMPLOYERS:
 
FROM - TO:
NAME & ADDRESS:
SALARY:
POSITION:
REASON FOR LEAVING:
 
 
FROM - TO:
NAME & ADDRESS:
SALARY:
POSITION:
REASON FOR LEAVING:
 
 
FROM - TO:
NAME & ADDRESS:
SALARY:
POSITION:
REASON FOR LEAVING:
 
REFERENCES:
 
NAME:
ADDRESS:
BUSINESS:
YEARS KNOWN:
 
 
NAME:
ADDRESS:
BUSINESS:
YEARS KNOWN:
 
 
NAME:
ADDRESS:
BUSINESS:
YEARS KNOWN:
 
AUTHORIZATION:


I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not, and is not intended, to be a contract of employment.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

 
* SIGNATURE:  
* DATE:  
 
* Enter the 3-letter security code shown:

      * Required Fields
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