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File Manager
Application for Employment
Pre-Employment Questionnaire — Equal Opportunity Employer
"We are a Drug Free Workplace"
Personal Information
First Name:
Last Name:
Address:
City:
State:
Zip:
Prior Address:
Prior City:
Prior State:
Prior Zip:
Telephone Number:
Email Address:
Referred By:
Please Select
Superior Employee
Newspaper
Netlook-Paper
Netlook-TV
Netlook-Web Site
Superior Web Site
Other
Where are you applying from?
Please Select
Office
Field
Home
Employment Information
Position: (select top 2 desired)
First Choice
Laborer
Backhoe Operator
Dozer Operator
Grader Operator
Pipe Layer
Roadway Foreman
Surveyors
Concrete Finisher
Carpenter
Pile Driver
Clerical
Foreman
Estimator
Superintendent
Mechanic
Truck Driver
Formsetter
Crane Operator
Loader Operator
Roller Operator
Operator
Project Operator
Second Choice
Laborer
Backhoe Operator
Dozer Operator
Grader Operator
Pipe Layer
Roadway Foreman
Surveyors
Concrete Finisher
Carpenter
Pile Driver
Clerical
Foreman
Estimator
Superintendent
Mechanic
Truck Driver
Formsetter
Crane Operator
Loader Operator
Roller Operator
Operator
Project Operator
Date you can start:
Desired Salary:
$
per hour
Are you currently employed?
Yes
No
If so, may we contact your current employer?
Yes
No
Have you ever applied to Superior before?
Yes
No
If yes, when/where?
Education
Select the highest grade completed:
Please Select
6th
7th
8th
9th
10th
11th
12th
College 1 Yrs
College 2 Yrs
College 3 Yrs
College 4 Yrs
College 5 Yrs
College 6 Yrs
College 8 Yrs
Name of High School
City/State
Graduate?
Degree?
Yes
No
Yes
No
Name of College
City/State
Graduate?
Type of Degree?
Yes
No
N/A
Associate
Bachelors
Masters
Doctorate
Other Education
City/State
Graduate?
Degree Type?
Yes
No
Job Related Skills:
Note: DO NOT complete any part you believe to be non-job related.
Do you fluently speak any other non-English language?
Yes
No
If so, please list:
If the job requires, do you have the appropriate valid driver's license?
Yes
No
What state is your driver's license issued in?
What type of driver's license do you have?
N/A
Class D
Class E
Learners Permit
Commercial
If your driver's license is a commercial driver's license, what type?
N/A
ClassA
ClassB
ClassC
What is your driver's license number?
Have you had any moving violations?
Yes
No
If so, please explain:
Have you ever been enlisted in the U.S. Military or Naval Service?
Yes
No
If so, what was/is your rank?
Please list any special subject of study, special training or skills.
References:
(Include only individuals familiar with your work ability. No relatives)
Name
Address/Phone
Years Known/Relationship
1
2
3
Employment History
Most Recent Employer
May we contact this employer?
Yes
No
Company Name:
Phone:
Employment Dates:
to
Fax:
Duties:
Salary:
Supervisor:
Reason for leaving:
Second Most Recent Employer
May we contact this employer?
Yes
No
Company Name:
Phone:
Employment Dates:
to
Fax:
Duties:
Salary:
Supervisor:
Reason for leaving:
Third Most Recent Employer
May we contact this employer?
Yes
No
Company Name:
Phone:
Employment Dates:
to
Fax:
Duties:
Salary:
Supervisor:
Reason for leaving:
Additional Comments:
Certification and Release
Please read the following and check "I Agree" below.
I certify that I have read and understand this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
Yes I Agree
I do not agree
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