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Employment Application

Application For Employment(Pre-Employment Questionnaire)

SRC of Lexington, Inc.

We consider applicants for employment without regard to race, color, religion, creed, sex, national origin, age, disability, veteran status, or any other legally protected status.


 Company Employee Friend Walk-in Employment Agency (Private or Government) Facebook Relative Other

DETAILS

 Yes No
 Yes No

 Yes No
 Yes No

 Yes No


Proof of citizenship or immigration status will be required upon employment
 Yes No

 Full time Part time Temporary

 Yes No

 Yes No

 Yes No

 Yes No

EDUCATION

(Copy of G.E.D., transcripts and diplomas are required)

High School or G.E.D.

Undergraduate College

Graduate Professional

Other (Specify) Business or Trade School

ACTIVITIES/ORGANIZATIONS/AWARDS

List any activities or organizations in which you have been involved, or awards you have received.

REFERENCES

Persons who know you well. List name, address, and telephone number of three business/work references who are not related to you or past supervisors listed elsewhere on this form. Business-related references preferred. Please provide at least one reference.

  1. Reference 1

  2. Reference 2

  3. Reference 3

  4. Reference 4

  5. Reference 5

EMPLOYMENT HISTORY

Provide the following information for your past and current employers, assignments or volunteer activities, starting with the most recent. Explain any gaps in employment in comments section below. Failure to provide complete information requested will result in rejection of application.

Employer 1






 Yes No




 Full Time Part Time


Employer 2






 Yes No




 Full Time Part Time


Employer 3






 Yes No




 Full Time Part Time


Employer 4






 Yes No




 Full Time Part Time


SKILLS

Qualifications and additional information. Summarize any special training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions for which you are applying. List any teams/committees/memberships on which you participated. State any additional information you feel may be helpful in considering your application.