Q-ZAR - Application for Employment

Pre-employment questionnaire..Equal Opportunity Employer

Personal Information

First Name *

Last Name *

Street Address *

City *

Zip Code *

Phone Number *

Email Address *

Referred By

Employment Desired

Position applying for *

Date to start *

Are you employed now? *

Yes

If so, may we inquire with them?

Yes

Have you ever applied with Q-ZAR before?

Yes

Where?

When?

Education History

Name & Location of Grammer School *

Years Attending *

Did You Graduate *

Subjects Studied

Name & Location of High School *

Years Attending *

Did You Graduate *

Subjects Studied

Name & Location of College School

Years Attending

Did You Graduate

Subjects Studied

Former Employers

List below last four employers, starting with last one first

Dates of employment? From/To

Name & Address of Employer

Salary?

Position?

Reason for leaving?

...

Dates of employment? From/To

Name & Address of Employer

Salary?

Position?

Reason for leaving?

...

Dates of employment? From/To

Name & Address of Employer

Salary?

Position?

Reason for leaving?

...

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 investigations of all statements contained herein and the references and employers listed above to give you any and 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 from utilization of such information. I also understand that no representative of the company has any authority to enter in to any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an Q-ZAR representative.

Date

Signature

Hours You Can Work: 10am - 11pm

Monday

Thursday

Friday

Saturday

Sunday