APPLICATION FOR EMPLOYMENT

(PRE-EMPLOYMENT QUESTIONNAIRE)
(AN EQUAL OPPORTUNITY EMPLOYER)
   
PERSONAL INFORMATION DATE     
Last First Middle
Name :    
Present Address : Street  
City  
State  
Zip  
Permanent Address : Street
City
State
Zip
Home Phone Are you 18 years or older?
Cell Phone
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED
IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS?		 YES NO
EMPLOYMENT DESIRED
Position :   Salary Desired :  
Date you can Start :      
Are you employed now?     
IF SO MAY WE INQUIRE OF YOUR PRESENT EMPLOYER :    
Ever apply to this company before?    
Where? When?
Referred by      
EDUCATION Name & Location of school No. of years attended Did you graduate Subjects Studied
Grammar School
High School
College
Trade, Business or Correspondence School
GENERAL
Subject of special study or research work :
Special skills :
Activities:  (CIVIC, ATHLETIC, ETC.)
EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, GENDER, AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.
U.S. Military or naval service : Rank :
Present membership in national guard or reserves :
FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS STARTING WITH LAST ONE FIRST    
Date month and year Employer name, address, phone & contact person Salary # Position Reason for leaving
From To    
From To     
From To     
# AVALON CARPET TILE AND FLOORING RESERVES THE RIGHT TO REQUEST PROOF OF PREVIOUS WAGES.
-  Applications that say "See  Resume" will not be considered.
REFERENCES   GIVE THE NAMES OF THREE PERSONS, NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR. 
Name Phone Business Years Acquainted
1.
2.
3.
Name Address Phone No.
IN CASE OF 
EMERGENCY NOTIFY
THE COMPANY HAS A COMPUTER EDUCATION PROGRAM THAT IS PART OF THE SALES REPRESENTATIVE TRAINING PROGRAM. DURING THE FIRST 90 DAYS OF HIRE, A NEW SALES REPRESENTATIVE WILL BE ASSIGNED TO THE COMPUTER EDUCATION PROGRAM. THE NEW SALES REPRESENTATIVE, AFTER COMPLETION OF THE COMPUTER EDUCATION EDUCATION PROGRAM MUST PASS A MINIMUM COMPUTER SKILLS TEST. IF THE NEW SALES REPRESENTATIVE IS UNABLE TO PASS THE COMPUTER SKILLS TEST, THE COMPANY WILL ARRANGE FOR FURTHER COMPUTER TRAINING AND A RETEST WITHIN 30 DAYS. IF THE NEW SALES REPRESENTATIVE IS STILL UNABLE TO PASS THE COMPUTER SKILLS TEST, AT THE COMPANY’S DISCRETION, THE SALES REPRESENTATIVE’S GUARANTEE MAY BE LOWERED UNTIL THEY ABLE TO PASS THE MINIMUM COMPUTER SKILLS TEST OR BE DISMISSED FROM THE COMPANY.

"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. 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 IT’S PRESIDENT, AND THEN ONLY 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 :  Name :