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Application for Employment

(Pre-Employment Questionnaire)(An Equal Opportunity Employer)

Personal Information
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
Education Details *
Education Name and Location of school * no of years attended * did you graduate? subjects studied
grammar school
high school
trade,business or correspondence school
General *
exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members.
* This form has been revised to comply with the provisions of the Americans with the Disablities Act and the th efinal regulations and interpretive guidence promulgated by the EEOC on July 26, 1991.
Former Employers * (list below last three employers, starting with the last one first)
  date, moth and year name and address of employer salary position reason for leaving
from to
from to
from to
References * give the names of three persons not related to you, whom you have known at least one year.
name address business years acquainted
the following statement applies in: Maryland & Massachusetts.
(Fill in name of states)
it is unlawful in the state of to require or administer a lie detector test as a subject to criminal penalties and civil liability
signature of applicant
"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered. My application may be rejected and, if I am employed, My employment may be terminated at any time.
In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any by the company. I understand that no company representative, other than it's president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."