Application For Employment Form (Pre-Employment Questionnaire)
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1
2APPLICATION FOR EMPLOYMENT
(Pre-Employment Questionnaire) (An Equal Opportunity Employer)
PERSONAL INFORMATION
DATE
SOCIAL SECURITY
NAME
NUMBER
LAST
FIRST
MIDDLE
PRESENT ADDRESS
STREET
CITY
STATE
ZIP
PERMANENT ADDRESS
STREET
CITY
STATE
ZIP
PHONE NO.
ARE YOU 18 YEARS OR OLDER?
Yes
No
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED
IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS?
Yes
No
EMPLOYMENT DESIRED
DATE YOU
SALARY
POSITION
CAN START
DESIRED
IF SO MAY WE INQUIRE
ARE YOU EMPLOYED NOW?
OF YOUR PRESENT EMPLOYER?
EVER APPLIED TO THIS COMPANY BEFORE?
WHERE?
WHEN?
REFERRED BY
*NO OF
*DID YOU
EDUCATION
NAME AND LOCATION OF SCHOOL
YEARS
SUBJECTS STUDIED
GRADUATE?
ATTENDED
GRAMMAR SCHOOL
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR
CORRESPONDENCE
SCHOOL
GENERAL
SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK
SPECIAL SKILLS
ACTlVITIES: (CIVIC ATHLETIC ETC.)
EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED. SEX. AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.
U. S MILITARY OR
PRESENT MEMBERSHIP IN
NAVAL SERVICE
RANK
NATIONAL GUARD OR RESERVES
*This form has been revised to comply with the provisions of the Americans with Disabilities Act
and the final regulations and interpretive guidance promulgated by the EEOC on July 26. 1991.
TOPS FORM 3285 (92-8)
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LITHO IN U.S.A.
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