ZEPHYR ELECTRIC

APPLICATION FOR EMPLOYMENT
PRE-EMPLOYMENT QUESTIONAIRE EQUAL OPPORTUNITY EMPLOYEE

Date:

Name:(Last name first)

Social Security Number:

Present Address:

Permanent Address:

Phone:

Referred by:

Desired Position:

Start Date:

Salary:

Currently Employed:
  Yes:   No:

Your Present Employer:

Ever Applied with us Before
  Yes:   No:

Where:

When:

EDUCATION:

High School:

Did you graduate?
Yes:   No:

College:

Did you graduate?
Yes:   No:

Trade / Business School
(Name & Address):

Did you graduate?
Yes:   No:

Subject Studied:

GENERAL INFORMATION

Subject of Special Study
Research Work or
Special training / Skills:

U.S. Military Service:
Yes:   No:

Rank:

Name & Address of Employer:

Position:

Salary:

Date:
from:    to:

Name & Address of Employer:

Position:

Salary

Date:
from:    to:

Name & Address of Employer:

Position:

Salary

Date:
from:    to:

Name & Address of Employer:

Position:

Salary:

Date:
from:    to:

REFERENCES:

Name:

Address:

Business:

Years Known:

Name:

Address:

Business:

Years Known:

Name:

Address:

Business:

Years Known:

AUTHORIZATION:

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 REFRENCES 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."

I Accept: I Decline:

Name: Date: