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APPLICATION FOR EMPLOYMENT

PRE-EMPLOYMENT QUESTIONNAIRE
EQUAL OPPORTUNITY EMPLOYER

PERSONAL INFORMATION		DATE

NAME (LAST NAME FIRST)		SOCIAL SECURITY NO.

PRESENT ADDRESS	CITY	STATE	ZIP CODE

PERMANENT ADDRESS	CITY	STATE	ZIP CODE

PHONE NUMBER		REFERRED BY

POSITION YOU ARE APPLYING FOR		DATE YOU CAN START	SALARY DESIRED

ARE YOU CURRENTLY EMPLOYED?		IF YES, MAY WE CONTACT YOUR PRESENT EMPLOYER?	PHONE #
yes No		yes No
HAVE YOU EVER APPLIED HERE OR BEEN EMPLOYED HERE BEFORE?		WHEN?
yes No

EDUCATION HISTORY
	NAME & LOCATION OF SCHOOL	YEARS ATTENDED	DID YOU GRADUATE	SUBJECTS STUDIED
GRAMMAR SCHOOL
MIDDLE SCHOOL
HIGH SCHOOL
COLLEGE / TRADE SCHOOL

GENERAL INFORMATION
SUBJECTS OF SPECIAL STUDY / RESEARCH WORK OR SPECIAL TRAINING / SKILLS
US MILITARY OR NAVAL SERVICE		RANK ACHIEVED

FORMER EMPLOYERS (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)
	DATE MONTH AND YEAR	NAME & ADDRESS OF EMPLOYER	SALARY	POSITION	REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO

REFERENCES GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
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 any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any 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.
INTERVIEWED BY

As the leading independent Vending Service Provider (VSP) in Atlanta, Georgia metro area, Atlanta Vending is continuously searching for hard working, dependable and energetic people to join our team.

If you would like to learn more about our organization, please submit your resume and cover letter to HRDirector@AtlantaVending.com or fax your information to:

Atlanta Vending

Attention: HR Director
Fax 770.448.6698

We look forward to learning about you and having you meet our team. Thank you.

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Atlanta Vending
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