Pre Screening Form PDF
Pre Screening Form PDF
PERSONAL INFORMATION
Date_______________
Name _____________________________________________________________________________________
Last First Middle Maiden
Present address ____________________________________________________________________________
Number Street City State Zip
Marital status: _________________________
Telephone ( )
e-mail __________________________________
EMPLOYMENT DESIRED
Position(s) applied for ____ ______________________
Employment desired FULL-TIME ONLY PART-TIME ONLY
When are you available to start work?
EDUCATION
TYPE OF NAME OF SCHOOL & MAJOR & YEARS
SCHOOL LOCATION SPECIALIZATION COMPLETED
High School
College/
university
Professional or
Graduate School
WORK EXPERIENCE
Please list your work experience for the past five years beginning with your most recent job held. If you
were self-employed, give firm name. Attach additional sheets if necessary.
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you
worked at this company.
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you
worked at this company.
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you
worked at this company.
____________________________________________________________________________________________
Have you ever been employed with this company? Yes No
If yes, when? ______________
Do you have any friends or relatives employed by this company? Yes No
If yes, please provide their names and relationship to you.
________________________________________
REFERENCES
Please list below three persons not related to you who have knowledge of your work performance and/or
personal qualifications within the last 5 years.
Name Occupation
Name Occupation
Name Occupation
Neither the acceptance of this application nor the subsequent entry into any type of
employment relationship, either in the position applied for or any other position, and
regardless of the contents of employee handbooks, personnel manuals, benefit plans,
policy statements, and the like as they may exist from time to time, or other Company
practices, shall serve to create an actual or implied contract of employment, or to confer
any right to remain an employee of , or otherwise to change in any respect the
employment-at-will relationship between it and the undersigned, and that relationship
cannot be altered except by a written instrument signed by the President /General
Manager of the Company. Both the undersigned and may end the employment
relationship at any time, without specified notice or reason. If employed, I understand
that the Company may unilaterally change or revise their benefits, policies and
procedures and such changes may include reduction in benefits.
I also understand that (1) the Company has a drug and alcohol policy that provides for
preemployment testing as well as testing after employment; (2) consent to and
compliance with such policy is a condition of my employment; and (3) continued
employment is based on the successful passing of testing under such policy.
______________________________
Date__________________________________