SURF-N-SEA, INC.
APPLICATION FOR EMPLOYMENT(PRE-EMPLOYMENT QUESTIONAIRE)(AN EQUAL OPPORTUNITY EMPLOYER)PERSONAL INFORMATION
NAME: ___________________________________________________________
LAST

FIRST

DATE: ___________________SOCIAL SECURITY
NUMBER: ________________

MIDDLEHOME ADDRESS: ________________________________________________________________________________STREET

CITY

STATEZIP

MAILING ADDRESS: ______________________________________________________________________________CITY

PHONE #: ____________________________STATE

ARE YOU 18 YEARS OR OLDER? Yes

ZIP

No

ARE YOU EITHER A U.S. CITIZEN OR AN ALIEN AUTHORIZED TO WORK IN THE UNITED STATES? Yes

No

EMPLOYMENT DESIREDDATE YOUPOSITION: ___________________________________ CAN START: ___________________SALARYDESIRED: __________IF SO MAY WE INQUIREARE YOU EMPLOYED NOW? ___________________ OF YOUR PRESENT EMPLOYER? ______________________
EVER APPLIED TO THIS COMPANY BEFORE? _________________________

WHEN? __________________REFERRED BY: ___________________________________________________________________________________EDUCATION

Name & location of school# ofYears
Attended

Did yougraduate?

Subjects StudiedHIGH SCHOOLCOLLEGETRADE,BUSINESS OR
CORR. SCHOOLGENERAL
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 OFORIGIN OF ITS MEMBERS.

U.S. MILITARY ORPRESENT MEMBERSHIP IN
NAVAL SERVICE: ________________ RANK: ____________NATIONAL GUARD OR RESERVES________________*The Age Discrimination in Employment Act of 1987 prohibits on the basis of age with respect to individuals who are at least 40 years of age.

(CONTINUED ON OTHER SIDE)FORMER EMPLOYERS (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)DATEMONTH &YEAR

NAME & PHONE NUMBER
OF EMPLOYERSALARYPOSITIONREASON FOR LEAVING

From:
To:
From:
To:
From:
To:
From:
To:

WHICH OF THESE JOBS DID YOU LIKE 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 ANDPHONE NUMBER

BUSINESSYEARSACQUAINTED

1.
2.
3.
IN CASE OF
EMERGENCY NOTIFY:_______________________________ PHONE NUMBER: _____________________________“I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I
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 LISTED ABOVE TO GIVE YOU ANY ANDALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, AND RELEASEALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.
I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OFPAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE AND WITHOUT CAUSE.”DATE: ______________

SIGNATURE: ___________________________________________________________AVAILABILITY:DAY:HOURS:SUNDAY______________DAY:
HOURS:MONDAY____________DAY:
HOURS:TUESDAY______________

WEDNESDAY__________THURSDAY____________FRIDAY_______________SATURDAY____________DO NOT WRITE BELOW THIS LINE
INTERVIEWED BY: ______________________________________________HIRED: YES

NO

DATE: __________________________POSITION: ____________________________ DEPT.: _________________________SALARY/WAGE: _____________________________ DATE REPORTING TO WORK: _________________________APPROVED: 1. ____________________________________________2. ____________________________________OWNERMANAGER