VOISARD MANUFACTURING
PRE-EMPLOYMENT QUESTIONAIRE

INSTRUCTIONS TO APPLICANT:
Answer all questions accurately and completely. Print legibly.
Applications remain active for a period of six months.


WE ARE AN EQUAL OPPORTUNITY EMPLOYER
PERSONAL INFORMATION
* NAME:  
* EMAIL ADDRESS:  
* STATE YOU ARE APPLYING TO:  
STREET: 
CITY: 
STATE: 
ZIP CODE: 
TELEPHONE:  
REFERRED BY:  
EMPLOYMENT DESIRED
POSITION:  
DATE YOU CAN START:  
SALARY DESIRED:  
ARE YOU SEEKING?:    FULL TIME    PART TIME   TEMPORARY   ANY AVAILABLE
ARE YOU 18 YEARS OR OLDER?:    Yes    No
ARE YOU CURRENTLY EMPLOYED?:    Yes    No
IF SO, MAY WE INQUIRE YOUR PRESENT EMPLOYER?:    Yes    No
ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?:    Yes    No
EDUCATION HISTORY List your most recent schooling
Dates Attended School School Name/Location Major Degree Approx Grad. Date GPA
SCHOOL 1
SCHOOL 2
SKILL INFORMATION SUBJECTS OF SPECIAL STUDY/RESEARCH WORK OR SPECIAL TRAINING/SKILLS
U.S. MILITARY SERVICE (OPTIONAL)
HAVE YOU SERVED IN THE U.S. MILITARY?(optional):    Yes    No
RANK/SKILLS:  
EMPLOYMENT HISTORY (List your last 3 employers, starting with the most recent)
Month/Year Name of company/
Complete Address 		Supervisor/
Telephone 		Nature
of Duties
From/To
From/To
From/To
REFERENCES (List below the names of two work-related individuals, whom you have known at least one year)
Name Occupation Address Telephone
GENERAL INFORMATION
Have you ever applied or worked for this Company?:    Yes    No
If yes, explain:  
Do you currently have immediate family working for this company?:    Yes    No
If yes, give name (s) and relationship (s):  
Is there any shift you can not work?:    1st Shift    2nd Shift   3rd Shift
Explain:  
Do you have any transportation restrictions that would prevent you from getting to work at specific times during the day or week?:    Yes    No
Explain:  
Have you ever been convicted of any felonies?:    Yes    No
If Yes, Explain:  
Voisard Manufacturing Interview Information Only
I certify that the facts contained in this application are true and complete to the best of my knowledge and I have not knowingly withheld any information. I understand and agree that any falsifications, omissions or misleading statements on this application or in my responses to questions asked during the interviewing or examination process will be grounds for immediate termination of employment if and whenever discovered.

I authorize the Company to contact references and former employers as indicated, and I authorize my previous employers to verify the information given on this application and during the interview process.

I understand that no one other than the Owner of the Company has authority to enter into any agreement and any such agreement will be signed by the Owner.

I understand that if employed, I will have the right to terminate my employment at any time, with or without cause, with or without notice, and that the Company has a similar right.

I understand that employment by the Company does not constitute a guarantee that any position will be continued for any length of time or that any job assignment or shift will be permanent.

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.

I understand I must have successful completion of pre-employment drug screening, as well as background and reference checks.

I understand that if employed, there will be Company policies and practices that are necessary to abide to.
• I hereby assert that the above information is correct and accurate.
• I agree that I have read, understand and agree to each of the above statements.

• Fill out your phone number, name, and today's date into the fields below to agree and submit this application.
Phone Number: 
Name: 
Date: 


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