PRE-EMPLOYMENT QUESTIONNAIRE

PRE-EMPLOYMENT QUESTIONNAIRE
Grasp N Pass is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an  applicant need reasonable accommodation in the application process, he or she should contact a company representative
Location you are applying for :     *
Date of Application:   Date
Applicant Personal Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Seconday Phone Number
Please enter a valid phone number.
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Date of Birth *

MonthDayYear
Date
Position(s) applying for*
Referred By: Name

PRE-EMPLOYMENT QUESTIONNAIRE
Former Employers (list below last three employers, starting with last one first)
1. DATE (MONTH AND YEAR) From:   Date & Month* To:   Date & Month*
Name and Address of Employer:     Company Name*       Address*
Supervisor:   First Name*   Last Name*
Position: Position*
Wage:   Wage*
Reason for Leaving:   Reason for leaving*
Supervisor Phone Number*
Please enter a valid phone number.
2. DATE (MONTH AND YEAR) From:   Date & Month To:   Date & Month
Name and Address of Employer:      Company Name      Address
Supervisor:   First Name   Last Name
Position: Position
Wage:   Wage
Reason for Leaving:   Reason for leaving
Supervisor Phone Number
Please enter a valid phone number.
3. DATE (MONTH AND YEAR) From:   Date & Month To:   Date & Month
Name and Address of Employer:       Company Name     Address
Supervisor:   First Name   Last Name
Position: Position
Wage:   Wage
Reason for Leaving:   Reason for leaving
Supervisor Phone Number
Please enter a valid phone number.

PRE-EMPLOYMENT QUESTIONNAIRE
References, (Please provide the name of three people not related to you, whom you have known for at least one year.
**NOTES: Reference Eligibility & Disqualification Criteria**
1.We don't accept immediate family (spouse, parent , siblings)
2.Friends Only with Professional Connection
3.Anyone unwilling to answer basic question
4.Fake or Unreachable reference

1. Name:   First Name*   Last Name*
Address:   Street Address*      City*   State*   Zip*
Business:   Business*
Years Known:   Years Known*
Reference Phone Number*
Please enter a valid phone number.
2. Name:   First Name   Last Name
Address:   Street Address   Address Line 2   City   State   Zip
Business:   Business
Years Known:   Years Known
Reference Phone Number
Please enter a valid phone number.
3. Name:   First Name   Last Name
Area Code   Phone Number
Address:   Street Address   Address Line 2   City   State   Zip
Business:   Business
Years Known:   Years Known
Reference Phone Number
Please enter a valid phone number.

PRE-EMPLOYMENT QUESTIONNAIRE
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 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 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, 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
Americans with Disabilities Act (ADA) and other relevant federal and state laws.
I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, and I give my full consent to Grasp N Pass LLC to perform my background check. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment”.In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States
and to complete the required employment eligibility verification document from upon hire.
Name*

First NameLast Name
Date: Date
Signature*

Note: For the next step in the hiring process, we will request a copy of your Social Security number and driver’s license.
Should be Empty:

PRE-EMPLOYMENT QUESTIONNAIRE

PRE-EMPLOYMENT QUESTIONNAIRE

Personal Information

PRE-EMPLOYMENT QUESTIONNAIRE

Education History

PRE-EMPLOYMENT QUESTIONNAIRE

PRE-EMPLOYMENT QUESTIONNAIRE

PRE-EMPLOYMENT QUESTIONNAIRE