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Application For Employment and Pre-Employment Questionnaire

The Mex-Itali Restaurant is an Equal Opportunity Employer
The Mex-Itali Restaurant strives to maintain a drug free workplace. Any employee found in violation will be subjected to corrective discipline up to and including termination of employment. It is understood that, as a condition of employment, anyone who is hired will be screened for illegal drugs. All employees are subject to random screening.
Personal Information
Application Date:
Name:
E-mail Address:
Present Address:
City, State Zip code:
Permanent Address:
City, State Zip code:
Telephone Number:
Referred By:
Employment Desired
Position:
Date You Can Start:
Salary Desired:
Are You Employed?

If So, May We Inquire Of Your Present Employer?

Have You Ever Applied To This Company Before?

If So, Where?
If So, When?
Education History
Grammar School:
Name and location of school:
Years attended:
Did you graduate?

Subjects studied:
High School:
Name and location of school:
Years attended:
Did you graduate?

Subjects studied:
College:
Name and location of school:
Years attended:
Did you graduate?

Subjects studied:
Trade, Business or Correspondence School:
Name and location of school:
Years attended:
Did you graduate?

Subjects studied:
General Information
Subjects of Special Study/Research Work or Special Training/Skills:
U. S. Military Service:
Military Rank:
Former Employers
(List below your last four employers, starting with last one first.)
Most Recent Employer:
Date (month and year):
From:
To:
Employer name and address:
Salary:
Position:
Reason for leaving:
Next Most Recent Employer:
Date (month and year):
From:
To:
Employer name and address:
Salary:
Position:
Reason for leaving:
Third Most Recent Employer:
Date (month and year):
From:
To:
Employer name and address:
Salary:
Position:
Reason for leaving:
Fourth Most Recent Employer:
Date (month and year):
From:
To:
Employer name and address:
Salary:
Position:
Reason for leaving:
References
Give below the names of three persons not related to you, whom you have known at least one year.
First Reference:
Name:
Address:

Business:
Years known:
Second Reference:
Name:
Address:

Business:
Years known:
Third Reference:
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 relevant federal and state laws."
Date Signed:
Type Your Legal Name: