Pre-Employment Questionnaire - Equal Opportunity Employer
Personal Information
First Name:
Last Name:
Present Address:
  
City:
State:
Zip:
Phone:
Social Security#:
Email Address:
Referred by:
Employment Desired
Position:
Mulligan's location desired:
Date You Can Start:
Salary Desired:
Are you currently employed: yes      no
If yes, may we contact your current employer? yes      no
Ever applied to this company before? yes      no
If yes, where & when?
Education History
Name & Location of School
Years attended
Did you graduate?
Subjects Studied
Grammar School:
yes
no
High School:
yes
no
College:
yes
no
Trade or Business School:
yes
no
General Information
Subjects of special study/research work or special training/skills
US Military Service (branch):
Rank:
Former Employers - (List below last 4 employers, starting with the last one first)
Date
Month & Year
Name & Address of Employer
Salary
Position
Reason for Leaving
From:
To:
From:
To:
From:
To:
From:
To:
References - List the names of three persons not related to you, whom you have known at least one year.
Name
Address
Business
Years Known
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 from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into 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 authorized company representative.

This waiver does not permit the release or use of disability - related or medical information in a manner prohibited by the Americans With Disabilities Act (ADA) and other revelant Federal and State laws."
Date: Digital Signature (name):