Candidate Questionnaire

I. Personal Info

First Name Middle Initial Last Name

Phone Number

Address

City State Zip Code

Position Applying For Referred By

Email AddressEmail Address is required to be in format user@example.com

My Preferred contact method is:

I understand in order to obtain employment, successful completion and passing of a physical and drug screen is required.

Yes No

II. Guidelines for Obtaining Employment

I am legally able to work in the United States.

Yes No

I am at least 18 years of age.

Yes No

My preferred method of payment is:

Direct Deposit Pay Card

I have or will have in the first 2 weeks of employment a bank account so that I can comply with the direct deposit policy.

Yes No

I have a High School diploma or GED equivalent.

Yes No

Name of High School or Issuing GED State:

III. General Production Requirements / Information

I have the ability to lift and carry up to 50 pounds repetitively.

Yes No

I have the ability to be on my feet (standing & walking) for up to 4 hours at a time.

Yes No

I have the ability to perform a job that includes repetitive stooping, bending.

Yes No

I have the ability to perform a job that includes repetitive crouching and crawling.

Yes No

I have the ability to perform a job that includes repetitive pushing and pulling.

Yes No

I have the ability to work in extreme temperatures.

Yes No

I have the ability to work in an extremely fast-paced environment with little supervision.

Yes No

I have a reliable way to get to and from work.

Yes No

The scheduled work week is Monday through Friday. I understand occasional overtime and Saturday work may be required.

Yes No

IV. Skills & Education

Please list all relevant skills, experience, licenses, or certifications:

Why would you be a great team member?

V. Work History (Most Current)

Most Recent

Name of Employer:

City: State:

Date Hired: Date Left:

Name and Position of Immediate Supervisor:

Position Held:

Final Pay Rate (Optional):

Job Duties:

Reason for Leaving:

Explain Reason for Leaving:

Name of Employer:

City: State:

Date Hired: Date Left:

Name and Position of Immediate Supervisor:

Position Held:

Final Pay Rate (Optional):

Job Duties:

Reason for Leaving:

Explain Reason for Leaving:

Name of Employer:

City: State:

Date Hired: Date Left:

Name and Position of Immediate Supervisor:

Position Held:

Final Pay Rate (Optional):

Job Duties:

Reason for Leaving:

Explain Reason for Leaving:

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my employment being terminated.