Applicant Screening Form
Name of Applicant
First Name
Middle Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Family Background
References
Applied Position
Â
Position Name
Expected Yearly Salary $
Date Applied
 -
Month
 -
Day
Year
Date
Date Available to Start
 -
Month
 -
Day
Year
Date
Do you have at least 3 years of experience for the position you are applying?
Yes
No
How many years of working experience do you have?
Less than 1 year
1 - 3 years
3 - 5 years
5 - 10 years
More than 10 years
Other
Do you have active driver's license?
Yes
No
Have you ever been guilty of a crime or been convicted of a crime?
Yes
No
Have you initiated or participated in any violence at work?
Yes
No
Are there any open/pending/processing legal proceedings that you are currently involved in?
Yes
No
Do you know anyone who is currently working or have worked for this company you are applying?
Yes
No
Do you have pending job applications with other companies?
Yes
No
The business does not tolerate drug use before or during the shift and will conduct drug testing as needed. Are you willing to comply?
Yes
No
Our company does not tolerate employees working under the influence of alcohol. Are you willing to comply?
Yes
No
Our company has restrictions on smoking. Are you willing to comply?
Yes
No
Are you willing to work flexible hours (such as rotating shifts, night shifts, weekends and on holidays)?
Yes
No
Are you willing to render overtime as required depending on the our company’s needs?
Yes
No
Our company does not tolerate employees working under the influence of alcohol. Are you willing to comply?
Yes
No
Please upload a profile and Government ID photo
Browse Files
Drag and drop files here
Choose a file
Cancel
of
I agree with the following statements
I hereby authorize the management of the company I am applying to investigate my background, and other details deemed necessary.
I hereby certify that all the information I have provided in this application form is correct and complete. I understand that any misrepresentation, falsification or willful concealment of facts may disqualify my application or lead to termination if I have been hired.
I understand that the information indicated in this form or conveyed during any interview with the management or representatives of the company is not intended to guarantee or be used as an employment contract. Likewise, I understand that filling out this form does not obligate the company to hire me.
I understand that I am fully responsible for answering the call of the company's office representative and submit all necessary required documents on time to avoid delay on the process of my employment and onboarding. I understand that any delay of submission and lack of my requirements may disqualify my application or, if hired, lead to my termination.
I have read and fully understand the content of this form and I give my consent on my own accord.
Date
 -
Month
 -
Day
Year
Date
Signature
Submit
Should be Empty: