Nichols Bros Online Employment Form

Online Employment Application:

Pre-Employment Questionnaire - (An Equal Opportunity Employer)
(Screening test for illegal drug use are required as a condition of employment)

Personal Information:

Date:

Last Name:

First Name:

Middle Name:

Street:

City:

State/Zip:


E-Mail:

Phone Number:

Are you 18 years or older?
Yes
No
Are you prevented from lawfully becoming employed in this country because of VISA or immigration status?
Yes
No

Employment Desired:

Position Desired:

Date You Can Start:

Salary Desired:

Are you employed now?
Yes
No
If so may we inquire of your present employer?
Yes
No
Ever applied to this company before?
Yes
No

Where did you apply to this company?

When did you apply to this company?

Referred By:

Education:

Name & Location
of School?

Number of Years Attended?

Did you Graduate?

Subjects Studies?

Grammar School:



High School:



College:



Trade, Business, or Correspondence School:


General:

Subjects of special study or research work:

Special skill:

Activities: (Civic, Athletic, Etc)
(Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color, or nation of origin of its members.)

US Military or Naval Service:

Rank:

Present Membership in National Guard or Reserves:

Former Employers: List below the last three employers, starting with the last one first.

Month, Date, & Year
Name & Address of Employer         Salary                  Position                   Reason for Leaving

From:
To:



From:
To:


From:
To:



From:
To:



References: Give the names of three persons not related to you, whom you have known at least one year.

                Name                                      Address                               Business        Years Acquainted

1:


2:


3: