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Pre-Employment Questionnaire

An Equal Opportunity Employer

IMPORTANT - ALL FIELDS ARE REQUIRED. PLACE A 0 (ZERO) FOR INAPPLICABLE FIELDS

How did you hear about this position:

Will you be living in Miami for this position?

Are you presently employed?

Yes No

Education
School Level	Name and Location	No. of years attended.	Graduated?	Subjects Studied
High School:			YesNo
College:			YesNo
Trade, Business, or Correspondence School			YesNo

General
Subjects of special study or research work:
Special Training:
Special Skills:

Former Employers

List below last three employers, starting with PRESENT/ most recent

Name of Present or Past Employer

Address

City	State	Zip

Starting Date	Leaving Date	Job Title

Weekly Starting Salary	Weekly final salary	May we contact your supervisor?
		YesNo
Name of Supervisor	Title	Phone

Description of Work:

Reason for Leaving:

Name of Previous Employer

Address

City	State	Zip

Starting Date	Leaving Date	Job Title

Weekly Starting Salary	Weekly final salary	May we contact your supervisor?
		YesNo
Name of Supervisor	Title	Phone

Description of Work:

Reason for Leaving:

Name of Previous Employer

Address

Weekly Starting Salary	Weekly final salary	May we contact your supervisor?
		YesNo

Name of Supervisor	Title	Phone

Description of Work:

Reason for Leaving:

Branch Of Service:		Discharge Date:
Have you been convicted of a felony within the last 5 years?		YesNo
If yes, explain (will not necessarily exclude you from consideration)

Additional comments

Employment Application