Showcase Media
APPLICATION FOR EMPLOYMENT
PRE-EMPLOYMENT QUESTIONNAIRE - AN EQUAL OPPORTUNITY EMPLOYER

PERSONAL INFORMATION
* = Required Field
*First Name:   *Last Name: *Soc. Sec. #:
*Present Address:     Apt.: *City: *State: *Zip:
*Permanent Address:     Apt.: *City: *State: *Zip:
*Are You 18 Years Or Older?:    YES    NO *Phone:  (Example: 123-123-1234)


DESIRED EMPLOYMENT
*Position:  *Date You Can Start: *Salary Desired:
*Are There Any Limitations To Days Or Evenings You Are Available?: 
*Are You Employed Now:    YES    NO If So, May We Contact Your Current Employer?:    YES    NO
  Are You Currently Working Full Or Part Time?:
*Who Referred You To Showcase Publications?:
Employment Agency    Newspaper Ad    Friend    State Employment Office    College Placement Service   
Walk In    Our Website    Job Service Website    Other


EDUCATION
School Level Name And Location Of School No. Of Years
Attended
Did You
Graduate?
Subjects Studied
*Grammar School
*High School
College  
Trade Business Or
Correspondence
School


GENERAL
Subjects Of Special Study Or Research Work:
Special Training:
Special Skills:
Do You Have Any Of The Following?: (Check All That Apply)
Computer    Scanner    Printer    Computer Experience    Dependable Transportation   
Do You Have Internet Access?:
If You Have Internet Access, What Type Service Do You Have?:


FORMER EMPLOYERS
LIST YOUR LAST THREE EMPLOYERS STARTING WITH THE MOST RECENT ONE FIRST
Name Of Present Or Last Employer:
Address:     City: State: Zip:
Starting Date:  Leaving Date: Job Title:
Weekly Starting Salary:  Weekly Final Salary:
May We Contact Your Supervisor:    YES   NO
Name Of Supervisor:  Title: Phone:
Description Of Work:
Reason For Leaving:


Name Of Present Or Last Employer:
Address:     City: State: Zip:
Starting Date:  Leaving Date: Job Title:
Weekly Starting Salary:  Weekly Final Salary:
May We Contact Your Supervisor:    YES   NO
Name Of Supervisor:  Title: Phone:
Description Of Work:
Reason For Leaving:


Name Of Present Or Last Employer:
Address:     City: State: Zip:
Starting Date:  Leaving Date: Job Title:
Weekly Starting Salary:  Weekly Final Salary:
May We Contact Your Supervisor:    YES   NO
Name Of Supervisor:  Title: Phone:
Description Of Work:
Reason For Leaving:


REFERENCES
BELOW, GIVE THE NAMES OF THREE PERSONS YOU ARE NOT RELATED TO, WHOM YOU HAVE KNOWN AT LEASE ONE YEAR.
Name Address Business Phone
Number
Years
Known
* * * *
* * * *
* * * *


RESUME
IF YOU HAVE A RESUME, USE THE BROWSE BUTTON BELOW TO LOCATE YOUR FILE.
YOUR FILE MUST BE IN THE MICROSOFT WORD .doc FORMAT.
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* = Required Field