TESI Application for Employment - New England Branch
(Pre-Employment Questionnaire) (An Equal Opportunity Employer)

Personal Information

Date:
 

Email:

Name:
Last
First
Middle
Zip

Present Address:
Street
City
State
Zip
  

Permanent Address:
Street
City
State
Zip
  

Phone Number:

ARE YOU 18 YEARS OR OLDER? Yes   No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Yes No

If Yes - Explain? 

Employment Desired

Position:

Date you can start:

  

Are you employed now?

If so may we inquire of your present employer? Yes   No

Ever applied to this company before?

Where?

When? 

Referred by:

  

Education

Name and Location of School

No of years
attended

Did you
Graduate?

Subjects Studied

Grammar School

 Yes   No

High School

 Yes   No

College

 Yes   No

Trade, Business or
Correspondence School

 Yes   No

General

Subject of special study or research work

Special Skills:

Activities:
(civic, athletic, etc.)
Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members

U.S. Military or Naval Service

 Yes   No

Rank:

Present membership in national guard or reserves

 Yes   No

Former Employers - (List below last three employers, starting with last one first).

Date
Month and Year

Name and Address of Employer

Salary

Position

Reason for Leaving

From:

To:

From:

To:

From:

To:

From:

To:

From:

To:

Which of these jobs did you like best?

What did you like most about this job?

References: (Give the names of three persons not related to you, whom you have known at least one year.

Name

Address

Business

Years
Acquainted

1 

2 

3 

The following statement applies in: Maryland & Massachusetts. (fill in name and state)
It is unlawful in the state of to require or administer a lie detector test as a condition of employment or continued employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Applicant Name:

In case of Emergency notify:

Name:

Address:

Phone No:
 

"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.
IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION.  I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY.  I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT.  HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING."

  

Date:     Signature: