Application for Employment

Pre-Employment Questionnaire – Equal Opportunity Employer.

Questions? Contact Greg Franklin
Phone: 817-926-8828
Fax: 817-429-5602

Personal Information
Name (Last Name First): Social Security No.
Present Address:
City:
State:
Zip:
Permanent Address:
City:
State:
Zip:
E-mail: Phone: Fax:
Referred by:
Employment Desired
Position:

 Date You Can Start:
 Salary Desired:
Are You Employed? Yes No
If So, May We Contact Your Present Employer? Yes No
Have You Ever Applied to
This Company Before? Yes No
 Where?
 When?
Education History
Name and Location of School Years
Attended		 Did You
Graduate?		 Subject Studied
Grammar School:
High School:
College:
Trade/Business/Correspondence:
General Information
Subjects of Special Study/Research
Work or Special Training/Skills:
U.S. Military or Naval Service:
Rank:
Former Employers (List below your last four employers, starting with the last one first.)
Date: Month and Year Name and Address
of Employer		 Salary Position Reason for Leaving
From
To
From
To
From
To
From
To
References (Give below the names of three persons not related to you, whom you have known at least one year.)
Name: Address: Phone: Business: Years
Known:
Résume

Upload Here:
(or fax to 817-429-5602)

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 references 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.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws."

DATE: SIGNATURE (initials):