Tarter Brothers Mechanical Inc.
Application For Employment
(Pre-employment Questionnaire) (An Equal Opportunity Employer)

Personal Information

Last Name
First Name
Middle Name
Social Security #
Current Address
Street
City
State & ZIP
Permanent Address
Street
City
State & ZIP
Phone #
Cell Phone #
E-mail Address:
Are Your 18 Years Or Older

Yes No

Are you prevented from lawfully becoming employed in this country beause of visa or immigration status?

Yes No

I Understand I may be subject to drug/alcohol testing. Please initial

Employment Desired

Position:
Start Date:
Salary Desired:
Are you employed now?
If so, provide information first under Employment History.

Yes No

Ever applied to this company before?

Yes No

Where?
When?
Referred by:

Education

Grammar School
Name & Location of School:
*# of years attended
*Did you graduate?
Subjects studied
High School
Name & Location of School:
*# of years attended
*Did you graduate?
Subjects studied
College
Name & Location of School:
*# of years attended
*Did you graduate?
Subjects studied
Trade, business or correspondence school
Name & Location of School:
*# of years attended
*Did you graduate?
Subjects studied

General

Subjects of special study or research work:
Special skills:
Activities: (civic, athletic, etc.)
Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members.
U.S. Military or Naval Service

Yes No

Rank achieved:
Present membership in National Guard or Reserves

Yes No

*This form complies with the provisions of the Americans with Disabilities Act and the final regulations and interpretative guidance promulgated by the EEOC on July 26, 1991.

Tarter Brothers Mechanical Inc.
Application For Employment
Page 2

Former Employers (list below last three (3) employers, starting with last one first)

Employer 1
Date: Month and Year
From:
To:
Name Of Employer
Address of Employer
Salary
Position
Reason for leaving
Employer 2
Date: Month and Year
From:
To:
Name Of Employer
Address of Employer
Salary
Position
Reason for leaving
Employer 3
Date: Month and Year
From:
To:
Name Of Employer
Address of Employer
Salary
Position
Reason for leaving
Employer 4
Date: Month and Year
From:
To:
Name Of Employer
Address of Employer
Salary
Position
Reason for leaving
Which of these jobs did you like best?
What did you like most about this job?

References: (Give the names of three (3) persons not related to you, whom you have known at least two years)

Person 1
Name:
Address:
Business
Years acquainted
Person 2
Name:
Address:
Business
Years acquainted
Person 3
Name:
Address:
Business
Years acquainted
In Case of an Emergency, Notify:
Name:
Address:
Phone #:
“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.

I hereby authorize a credit and/or criminal check to be made, verification of information I provided and communication with any and all names listed on this application.

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 time by the company. I understand that no company representative, other than its 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.”
Date:
Signature: