Job Pre Application

JOB PRE-APPLICATION

This pre-application collects basic employment eligibility and background information for preliminary review. Completion of this form does not guarantee an interview or employment. False statements or omissions may disqualify the applicant or be grounds for termination if discovered after hire.

Applicant Information

Applicant Name:

Position and Availability

Date Available to Start:

Full-time    Part-time    Temporary    Internship

Education

Employment History (Most Recent First)

Employer 1

Position:    Start Date:    End Date:

Employer 2

Position:    Start Date:    End Date:

References

Eligibility and Background Questions

Are you legally authorized to work in this country?   Yes    No

Have you ever been convicted of a felony?   Yes    No

Have you ever been terminated or asked to resign from a position?   Yes    No

Authorization and Certification

I certify under penalty of perjury that the information provided in this pre-application is true, complete and correct to the best of my knowledge. I authorize the employer and its agents to investigate and verify all statements on this form and any attached documents, including contacting prior employers and references and obtaining consumer reports where permitted by law. I release all parties from liability for any damages that may result from furnishing such information.

I understand that this pre-application is for screening purposes only. No employment contract is created by the submission of this form. Any offer of employment will be conditioned upon satisfactory completion of reference checks, background checks, and other pre-employment requirements as applicable, and will be subject to the employer’s policies.

Consent to background check:   I consent to a background and reference check in connection with my application.

Confidentiality of Applicant Data

Applicant data provided on this form will be used only for hiring-related purposes and maintained in accordance with applicable privacy and employment laws. The employer will not disclose applicant data except as required for verification, background checks, or as required by law.

Acknowledgment

I acknowledge that I have read and understand the statements above and that any misrepresentation or omission of material facts may result in rejection of this application or termination of employment if discovered later.

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