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PRE-EMPLOYMENT QUESTIONAIRE – AN EQUAL OPPORTUNITY EMPLOYER

PERSONAL INFORMATION

EMPLOYMENT DESIRED

EDUCATION

NOTE: This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.
(EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.)

FORMER EMPLOYERS

LIST LAST FOUR EMPLOYERS STARTING WITH MOST RECENT FIRST

REFERENCES

LIST THE NAMES OF THREE PERSONS NOT RELATED TO YOU THAT YOU HAVE KNOWN AT LEAST ONE YEAR
If yes, explain below.
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 already employed, my employment may be terminated at any time. 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 the president -- and then only in writing signed by the president -- has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.
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