Stone Werks

Application for Employment

Pre employment Questionnaire. An equal opportunity employer

Last Name

First Name

Social Security Number

Address (street, apt #)

Home Phone

City

State

Zip

Cell Phone

Stonewerks Location you are applying for

Are you 18 years or older? Yes No

Desired Employment
Position
Date you can Start
Desired Wage

Are you eligible for employment in the USA?	Yes	No
Are you currently employed?	Yes	No
Have you ever applied with this company before?	Yes	No
Have you ever worked for this company before?	Yes	No

Please list your availability (select all shifts you can work)

Full/Part Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

If Yes, what was your reason for leaving?
How were you referred to this company?

Education

Grammar School Name and Location	Years Attended	Did you graduate?	Subjects Studied
High School Name and Location	Years Attended	Did you graduate?	Subjects Studied
College/University School Name and Location	Years Attended	Did you graduate?	Subjects Studied
Trade School Name and Location	Years Attended	Did you graduate?	Subjects Studied

General

Subjects of Special Study or Research Work	Special Skills
Special Training

Former Employers (below list three employers starting with the most recent)

Employers Name		Starting Date	Leaving Date
Address		Starting Pay	Leaving Pay
City	State	Supervisor's Name
Job Title		Supervisor's Title

Employers Name		Starting Date	Leaving Date
Address		Starting Pay	Leaving Pay
City	State	Supervisor's Name
Job Title		Supervisor's Title

Employers Name		Starting Date	Leaving Date
Address		Starting Pay	Leaving Pay
City	State	Supervisor's Name
Job Title		Supervisor's Title

Please List Three References

Name		Phone
Address		Years Acquainted

Name		Phone
Address		Years Acquainted

Name		Phone
Address		Years Acquainted

Service Record

Branch of Service

Rank

Discharge Date

Have you ever been convicted of a felony within the last 5 years?

If yes, please explain (will not necessarily exclude you from consideration).

Resume

Please paste your resume
(optional):

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 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 employer for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative.

I confirm that all information is true and correct.