Structural Engineers - Structural Dynamics, Inc.



Application for employment
Pre-employment questionnaire - an equal opportunity employer
All information submitted will remain in strictest confidence and will only be used for purposes of evaluating.

Personal Information
First Name:
Last Name:
Present Address:
City:
State:
Zip:
       
Permanent Address:
City:
State:
Zip:
       
Social Security No.
- - Phone:
- -
18 years or older?  Yes   No            E-mail Address: 
       
       
       
Desired Employment
      
Position:
Available  
   / /
Salary Desired:
Start Date:  
 (month) / (date)  /     (year)
Are you employed now?
    Yes    No
If so, may we
contact them?
Yes    No
Ever applied to this company before?
    Yes    No
If so, when?  
Ever worked for this company before?
    Yes    No
If so, when?  
Reason for leaving:
Name of last supervisor:
 
Who referred you to this company?    Employment Agency
     News Ad
    Friend
   Employment Office       Internet        Other
       
       
Education
      
     
Grammar School:
  
No. of years attended:          Did you graduate?    Yes    No
 
High School:
   
No. of years attended:          Did you graduate?    Yes    No
Subjects Studied:   
 
College:   
No. of years attended:          Did you graduate?    Yes    No
Subjects Studied:   
 
Trade, Business or Correspondence School:   
No. of years attended:          Did you graduate?    Yes    No
Subjects Studied:   
       
       
General Information
      
   
Do you have any...  
 
Subjects of specialty study or research work   
Special Training   
Special Skills   
       
Do you have a valid drivers license?
    Yes    No
If so, what type? 
       
       
Former Employers
      
List below your last 3 employers, starting with the most recent
1) Name of Employer:
Address:
City:
State:
Zip:
Starting Date:
  / / Leaving Date:
  / /
   (month) / (date)  /     (year)    (month) / (date)  /     (year)
Job Title:
Weekly Starting Salary:
   
Weekly Final Salary:
   
May we contact your supervisor?
    Yes    No
   
Name of Supervisor:
Description of work:
Reason for leaving:
       
       
2) Name of Employer:
Address:
City:
State:
Zip:
Starting Date:
  / / Leaving Date:
  / /
   (month) / (date)  /     (year)    (month) / (date)  /     (year)
Job Title:
Weekly Starting Salary:
   
Weekly Final Salary:
   
May we contact your supervisor?
    Yes    No
   
Name of Supervisor:
Description of work:
Reason for leaving:
       
       
3) Name of Employer:
Address:
City:
State:
Zip:
Starting Date:
  / / Leaving Date:
  / /
   (month) / (date)  /     (year)    (month) / (date)  /     (year)
Job Title:
Weekly Starting Salary:
   
Weekly Final Salary:
   
May we contact your supervisor?
    Yes    No
   
Name of Supervisor:
Description of work:
Reason for leaving:
       
     
References
Below, give the names of three persons you are not related to, whom you have known at least one year.
1)         Name:
Address:
City:
State:
Zip:
Business:
Years Acquainted:
   
       
2)         Name:
Address:
City:
State:
Zip:
Business:
Years Acquainted:
   
       
3)         Name:
Address:
City:
State:
Zip:
Business:
Years Acquainted:
   
       
       
     
Service Record (If applicable)
       
Branch of Service:
Discharge Rank:
Discharge Date:
/ /    
       
     
Have you been convicted of a felony within the last 5 years?     Yes    No
If yes, explain:

(Will not necessarily exclude you from consideration)
       
     
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 investigation 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 form all liability for any damage that result from utilization of such information.