Shear Southern Hair & Color Day Spa - Pre-Employment Questionnaire

Pre-Employment Questionnaire

Enter the date: -- mm/dd/yy

PERSONAL INFORMATION

LAST NAME
FIRST NAME
MIDDLE
SOCIAL SECURITY NO:

PRESENT ADDRESS
CITY
STATE	ZIP CODE
PERMANENT ADDRESS
CITY
STATE	ZIP CODE
PHONE NO:

EMPLOYMENT DESIRED

POSITION
DATE YOU CAN START
SALARY DESIRED
ARE YOU EMPLOYED?	YES NO
IF SO, MAY INQUIRE OF YOUR PRESENT EMPLOYER?	YES NO
EVER APPLIED TO THIS COMPANY BEFORE?	YES NO
IF SO, WHERE?	WHEN?

EDUCATION HISTORY

GRAMMAR SCHOOL NAME
YEARS ATTENDED	DID YOU GRADUATE? YES NO
SUBJECT STUDIED
HIGH SCHOOL NAME
YEARS ATTENDED	DID YOU GRADUATE? YES NO
SUBJECT STUDIED
COLLEGE NAME
YEARS ATTENDED	DID YOU GRADUATE? YES NO
SUBJECT STUDIED
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL NAME
YEARS ATTENDED	DID YOU GRADUATE? YES NO
SUBJECT STUDIED

GENERAL SUBJECTS OF SPECIAL STUDY/RESEARCH WORK/SPECIAL TRAINING SKILLS

U.S. MILITARY SERVICE
RANK

FORMER EMPLOYERS

(List last four employers, starting with last one first)

START DATE	END DATE
EMPLOYER NAME
ADDRESS
CITY
STATE	ZIP CODE
POSITION
REASON FOR LEAVING
PHONE NO:

2ND FORMER EMPLOYER

START DATE	END DATE
EMPLOYER NAME
ADDRESS
CITY
STATE	ZIP CODE
POSITION
REASON FOR LEAVING
PHONE NO:

3RD FORMER EMPLOYER

START DATE	END DATE
EMPLOYER NAME
ADDRESS
CITY
STATE	ZIP CODE
POSITION
REASON FOR LEAVING
PHONE NO:

4TH FORMER EMPLOYER

START DATE	END DATE
EMPLOYER NAME
ADDRESS
CITY
STATE	ZIP CODE
POSITION
REASON FOR LEAVING
PHONE NO:

REFERENCES

(Give Below The Names Of Three Persons NOT Related To You, Whom You Have Known For At Least One Year)

REFERENCE ONE

NAME
ADDRESS
CITY
STATE	ZIP CODE
BUSINESS
PHONE NO:
YEARS KNOWN

REFERENCE TWO

NAME
ADDRESS
CITY
STATE	ZIP CODE
BUSINESS
PHONE NO:
YEARS KNOWN

REFERENCE THREE

NAME
ADDRESS
CITY
STATE	ZIP CODE
BUSINESS
PHONE NO:
YEARS KNOWN

AUTHORIZATION

" 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."

I AGREE TO THE ABOVE STATEMENT

An Equal Opportunity Employer