Application for Employment | Steamers Seafood

Pre-Employment Questionaire - Equal Opportunity Employer

Last Name:

First Name:

Present Address:

City:

State:

Zip Code:

Phone Number:

Email:

Referred By:

Position:

Date You Can Start:

Are you employed?

Yes

If so, may we inquire of your present employer?

Yes

Have you ever applied to Steamer Seafood before?

Yes

When?

High School

Name & Location Of School:

Year of Graduation:

College

Name & Location Of School:

Years Attended:

Did You Graduate?

Yes

Subjects Studied:

Subjects Of Special Study/Research Work Or Special Training/Skills:

U.S. Military Or Naval Service:

Rank:

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

Employer One

From:

To:

Name Of Employer:

Address Of Employer:

Salary:

Position:

Reason For Leaving:

Employer Two

From:

To:

Name Of Employer:

Address Of Employer:

Salary:

Position:

Reason For Leaving:

Give below the names of three persons not related to you, whom you have known at least one year.

Reference One

Name:

Address:

Phone:

Business:

Years Known:

Reference Two

Name:

Address:

Phone:

Business:

Years Known:

Reference Three

Name:

Address:

Phone:

Business:

Years Known:

"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.

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."

Yes, I agree