HR Questionnaire Template

HR Questionnaire Template

Personal Information

Position Information

Desired Start Date:    Salary or Pay Rate:

Full-time    Part-time    Contract    Internship

Employment History

Employer 1

Dates Employed:    Supervisor:

Employer 2

Dates Employed:    Supervisor:

Education

Major/Field:    Graduation Date:

References

Reference 1

Reference 2

Reference 3

Skills, Certifications & Languages

Legal Disclosures and Authorizations

At-Will Employment Statement: Employment with the employer is on an at-will basis. Either the applicant or the employer may terminate the employment relationship at any time, with or without cause or prior notice, unless a written agreement signed by an authorized representative specifies otherwise.

Equal Opportunity Statement: The employer provides equal employment opportunity without regard to race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable law.

Authorization to Contact and Background Checks: By signing below, the applicant authorizes the employer to contact previous employers, educational institutions, and references and to obtain background checks, credit checks to the extent permitted by law, and any other pre-employment inquiries necessary to evaluate suitability for employment. The applicant further certifies that all information provided is true and complete.

I authorize contact with prior employers:    I authorize background checks:

Eligibility & Disclosures

Are you legally authorized to work in the country of employment?    Yes    No

Have you ever been convicted of a felony? (A conviction will not necessarily disqualify an applicant from employment.)    Yes    No

Emergency Contact

Applicant Certification

I certify that all information provided in this questionnaire and any accompanying documents is true, complete and accurate to the best of my knowledge. I understand that false statements, omissions, or misrepresentations may be grounds for refusal of employment or, if employed, termination. I agree to notify the employer of any change in the information provided.

I further acknowledge that nothing in this questionnaire shall constitute a contract of employment for any specified period of time. I understand that employment, if offered and accepted, is at-will, subject to the At-Will Employment Statement above.

Consent to Release: I authorize the release of employment-related information, including but not limited to employment dates, job performance, and eligibility for rehire, from my prior employers and educational institutions to the employer for the purpose of evaluating my application.

Applicant initials to acknowledge consent:

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