PRE-EMPLOYMENT QUESTIONAIRE EQUAL OPPORTUNITY EMPLOYER * indicates required field PERSONAL INFORMATION Name:* Email:* Subject:* Social Security Number:* Present Address:* Permanent Address:* Phone Number:* Referred by: EMPLOYMENT DESIRED Position applying for: Date you can start: Salary Desired: Currently Employed?* Yes No Can we contact your current employer? Yes No Have you ever applied at StandFast Packaging before?* Yes No If so, where and when? EDUCATION HISTORY Grammer School: Years Attended: Did you graduate? Yes No High School: Years Attended High School: Did you graduate High School? Yes No College: Years Attended College: Did you graduate College? Yes No Areas of study: GENERAL INFORMATION Subjects of special study/research work or special training/skills: MILITARY SERVICE Branch: Dates of Service: Highest Rank Held: Military Occupational Specialty : Active Reserve Commitment: Yes No If yes, date commitment ends: FORMER EMPLOYMENT Please list dates of employment, Name & Address of employer, Ending Salary, Position, and Reason for Leaving FORMER EMPLOYMENT 2 Please list dates of employment, Name & Address of employer, Ending Salary, Position, and Reason for Leaving FORMER EMPLOYMENT 3 Please list dates of employment, Name & Address of employer, Ending Salary, Position, and Reason for Leaving FORMER EMPLOYMENT 4 Please list dates of employment, Name & Address of employer, Ending Salary, Position, and Reason for Leaving GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR. Reference #1 Name Reference #1 Address Reference #1 Business Reference #1 Years Known Reference #2 Name Reference #2 Address Reference #2 Business Reference #2 Years Known Reference #3 Name Reference #3 Address Reference #3 Business Reference #3 Years Known "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. AUTHORIZATION Agree Disagree CAPTCHA Code:*
