Showcase Media
APPLICATION FOR EMPLOYMENT
PRE-EMPLOYMENT QUESTIONNAIRE - AN EQUAL OPPORTUNITY EMPLOYER
PERSONAL INFORMATION
*
= Required Field
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First Name:
*
Last Name:
*
Soc. Sec. #:
*
Present Address:
Apt.:
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City:
*
State:
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Zip:
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Permanent Address:
Apt.:
*
City:
*
State:
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Zip:
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Are You 18 Years Or Older?:
YES
NO
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Phone:
(Example: 123-123-1234)
DESIRED EMPLOYMENT
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Position:
-Select One-
Sales
Distribution
Print Production
Internet Production
Accounting
Administration
Other
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Date You Can Start:
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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?:
-Select One-
NA
Full Time
Part Time
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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
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Grammar School
Select
Yes
No
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High School
Select
Yes
No
College
Select
Yes
No
-NA-
Trade Business Or
Correspondence
School
Select
Yes
No
-NA-
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?:
Select
Yes
No
If You Have Internet Access, What Type Service Do You Have?:
Select
NA
Cable
DSL
Dial Up
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
*
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*
*
*
*
*
*
*
*
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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.
Upload Your Resume
Find Resume
*
= Required Field