Prospective employee questionnaire

 

 

Last Name                        First          Middle   

____________________________________________________                            

 

Date of Birth:  ___\___\___    Place of birth_____________________________________

 

Social security  # :      -      -

 

Phone #: (     )       -                  Cell # : (     )       -

                                   

Present Address:

Street                                       City                              State  Zip

_________________________________________________________________________________

 

Permanent Address

Street                                       City                              State  Zip

_________________________________________________________________________________

         

Are you legally in the  U.S.?     YES             NO

 

Year of entry to the USA:

 

Country of origin: _________________________________________________________

 

In case of emergency, notify:

_________________________________________________________________________________

_________________________________________________________________________________

 

 Education:

 

High School: Name and address,  year finished

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

 

College:  Name and address, year finished, subject of study, degree

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

 

Special training or skills (construction, landscaping, computer skills, machine operation, etc.)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Former employers (list below your employers in the last 10 years, starting with most recent one first,

also include any other employers more than 10 years ago where you had specific experience

you would like considered)

 

Name, Address, and Phone # of Company and Type of Business

 

Employer 1

_________________________________________________________________________________

_________________________________________________________________________________

From (MM/YY)__________________ To (MM/YY)__________________

Describe in Detail the work you did ___________________________________________________

_________________________________________________________________________________

starting   salary              last salary                    reason for leaving

_________________________________________________________________________________

 

 

Employer 2

_________________________________________________________________________________

_________________________________________________________________________________

From (MM/YY)__________________ To (MM/YY)__________________

Describe in Detail the work you did ___________________________________________________

_________________________________________________________________________________

starting   salary              last salary                    reason for leaving

_________________________________________________________________________________

 

Employer 3

_________________________________________________________________________________

_________________________________________________________________________________

From (MM/YY)__________________ To (MM/YY)__________________

Describe in Detail the work you did ___________________________________________________

_________________________________________________________________________________

starting   salary              last salary                    reason for leaving

_________________________________________________________________________________

 

Employer 4

_________________________________________________________________________________

_________________________________________________________________________________

From (MM/YY)__________________ To (MM/YY)__________________

Describe in Detail the work you did ___________________________________________________

_________________________________________________________________________________

starting   salary              last salary                    reason for leaving

_________________________________________________________________________________

 

 

Which of these jobs did you like best? ____________________________   Why? _______________________________

_________________________________________________________________________________

References:

 

Give the names of three persons not related to you whom you have know at list one year

 

Name

Address

Business

Phone Number

Years Acquinted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been convicted of a crime, other then a minor traffic violation?        Yes            No

 

Family members: list names and age of your children:

 

 

 

 

Applican signature   ______________________________      Date   _________________________