Application for Employment

PRE-EMPLOYMENT QUESTIONNAIREnEQUAL OPPORTUNITY EMPLOYER

Personal Information
Name*
First Last
Social Security Number*
Email*
Physical Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
(###) ###-####
Referred By
Employment Desired
Position
Date You Can Start
Salary Desired
Are You Employed?
- Yes
- No
If So, May We Contact Your Present Employer?
- Yes
- No
Ever Applied To BMA Before?
- Yes
- No
When?
Position Held?

Education History
Grammer School
Did You Graduate?
- Yes
- No
Years Attended
Subjects Studied
High School
Did You Graduate?
- Yes
- No
Years Attended
Subjects Studied
College
Did You Graduate?
- Yes
- No
Years Attended
Subjects Studied
Trade, Business or Correspondence School
Did You Graduate?
- Yes
- No
Years Attended
Subjects Studied
General Information
Subjects of Special Study/Research Work or Special Training/Skills
U.S. Military or Naval Service
Rank/Status

Former Employers
(LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Name of Employer
Address of Employer
Street Address Address Line 2 City State ZIP Code
Position
Salary
Reason For Leaving
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Name of Employer
Address of Employer
Street Address Address Line 2 City State ZIP Code
Position
Salary
Reason For Leaving
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Name of Employer
Address of Employer
Street Address Address Line 2 City State ZIP Code
Position
Salary
Reason For Leaving
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Name of Employer
Address of Employer
Street Address Address Line 2 City State ZIP Code
Position
Salary
Reason For Leaving

References
GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOW AT LEAST ONE YEAR
Name
First Last
Address
City State
Phone
(###) ###-####
Years Known
Please enter a number from 0 to 100.
Name
First Last
Address
City State
Phone
(###) ###-####
Years Known
Please enter a number from 0 to 100.
Name
First Last
Address
City State
Phone
(###) ###-####
Years Known
Please enter a number from 0 to 100.
HAVE YOU BEEN CONVICTED OF A CRIME WITHIN THE PAST 7 YEARS YEAR’S? IF YES PLEASE EXPLAIN:
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 prohabited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”
Todays Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
Captcha

Area Index	Today's Reading
Medina Reservoir Elevation	818.10
Medina Reservoir Storage Acre Feet	12,690
Diversion Reservoir Elevation	906.3

Water For	Month	YTD
Municipal Usage	0	0
Irrigation Usage Acre Feet	0.00	0.00

Application for Employment

APPLICATION FOR EMPLOYMENT

Step 1 of 4

Personal Information

Employment Desired

Education History

General Information

Former Employers

References

AUTHORIZATION