Pre-Employment Questionaire from an Equal Opportunity Employer
* This form has been revised to comply with the provisions of the American Disabilites Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, flasified 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."
Your social security number and offical signature will only be required at time of employment. Thank You
This form has been designed to strictly comply with State and Federal fair employment proctices laws prohibiting employment discrimination. This application form is of general standard use throughout the United States and assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.
Additional request for job qualifications, in the form of a resume, may be required for certain positions.