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Pre-Employment Questionnaire
An Equal Opportunity Employer
IMPORTANT - ALL FIELDS ARE REQUIRED. PLACE A 0 (ZERO) FOR INAPPLICABLE FIELDS
Name (Last Name First)
Birth Date
Phone + Area Code
Email
Desired Employment
Position
Desired Income
Date you can Start
Sales professional
Select One $0 - $10k /Year $10 - $15k /Year $15 - $20k /Year $20 - $25k /Year $25 - $30k /Year $30 - $35k /Year $35 - $40k /Year $40 - $45k /Year $45 - $50k /Year $50 - $55k /Year $55 - $60k /Year $60 - $65k /Year $65 - $70k /Year $70 - $75k /Year $80 k + /Year
Former Employers
List below last three employers, starting with PRESENT/ most recent
Name of Present Employer
Address
City
Starting Date
Monthly Salary
YesNo
Name of Supervisor
Title
Phone
Description of Work:
Reason for Leaving:
Name of Previous Employer
Have you been convicted of a felony within the last 5 years?
If yes, explain (will not necessarily exclude you from consideration)
Additional comments
