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Application For Employment (Pre-employment Questionnaire) (An Equal Opportunity Employer)

Personal Information
Employment Desired
Special Skills Or Certifications
Former Employers

List Below your last three employers, starting with the most recent first.

Employer 1

Employer 2

Employer 3


Give the names of three people not related to you, whom you have known for at least one year

Reference 1

Reference 2

Reference 3

Physical Record
Criminal Record

“I certify that the facts contained in this application are true and completed to the best of my knowledge and understand that, if employed, falsified information 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 and all information concerning my previous employment and pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I give Premier at Sawmill permission to seek a copy of my arrest record from the Franklin County Sheriff’s Office. I do hereby release the Franklin County Sheriff’s Office and all individuals connected therewith from all liability. I understand and agree that, if hired, my employment is for no definite period and may, regardless of date of payment of my wages and salary, be terminated without any prior notice.”

* Denotes Required Field

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