Windy Hill

Application For Employment

(Pre-Employment Questionnaire) (An Equal Opportunity Employer)

Personal Information

Date

Name

Present Address

Permanent Address

Phone No

Are You 18 Years Or Older?

Yes No

Are You Prevented from lawfully becoming employed in this country because of visa or immigration status?

Yes No

Employment Desired

Position

Date you can start

Salary Desired

Are you employed now?

if so may we inquire of your present employer?

ever applied to this company before?

Where

when

Referred By

EDUCATION	Name And Location Of School	* No Of Years Attended	* Did You Graduate?	Subjects Studied
Grammar School
High School
College
Trade, Business or Correspondence School

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

rank

present membership in national guard or reserves

*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.

Former employers (List below last three employers, starting with last one first).

Date month and year	Name and Telephone number	salary	position	reason for leaving
From: To:
From: To:
From: To:

Which of these jobs did you like the best?

what did you like most about this job?

References: give the names of three persons not related to you, whom you have known at least one year.

	Name	Address/Telephone	Business	Years Acquainted
1
2
3

the following statement applies in: maryland & massachusetts (Fill in name of state)
it is unlawful in the state of to require or adminster a lie detector test as a condition of employment or continued employment. an employer who violates this law shall be subject to criminal penalties and civil liability.

Signature of Applicant

in case of emergency notify

name

address

phone no

"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 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." I also authorize you to call former employers and references.

Date

Signature

Do not write below this line

interviewed by

Date

Remarks:

neatness

ability

hired

Yes No

position

dept

salary/wage

date reporting to work

approved

employment manager

dept. head

general manager

This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment Form is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.