Application For Employment

PRE-EMPLOYMENT QUESTIONNAIRE AN EQUAL OPPORTUNITY EMPLOYER

PERSONAL INFORMATION
Full Name*
Email*
Present Address*
City*
State*
Zip Code*
Are You 18 Years or Older?*
- Yes
- No
Phone*
Desired Employment
Position*
Date you can start
Salary Desired
Are you employed now?
- Yes
- No
If so may we inquire of your present employer?
- Yes
- No
Ever applied to this company before?
- Yes
- No
When?
Ever worked for this company before?
- Yes
- No
When?
Name of last supervisor at this company
Who referred you to this company?
- Employment Agency
- Newspaper Advertising
- Friend
- State employment office
- College placement service
- Walk in
- Other
References
Name
Address
Business
Years acquainted
Reference Name 2
Reference Address 2
Reference Business 2
Reference Years acquainted 2
Reference Name 3
Reference Address 3
Reference Business 3
Reference Years acquainted 3
Education History
Name Of Education
Year
Year
Year
Year
Education History
Name of High School Vocation/Trade School
High School
Name of College/University School
College/University
Name of Graduate/Professional School
Graduate/Professional
Diploma/Degree
Describe Course of Study
Describe Specialized Training, Apprenticeship, Skills and Extra Curricular Activities
Employment Experience
Start with your present or last job. Include military service assignments and you may include work performed on a volunteer basis. Exclude organization names which indicate race, color, ancestry, sex, marital status, national origin, age, handicap, or sexual orientation.
Employer (1) (if NONE, please type NONE)*
Address*
Phone*
Start Date*
MM slash DD slash YYYY
Leave Date*
MM slash DD slash YYYY
May we contact?*
- Yes
- No
Job Title*
Supervisor and Title*
Reason for leaving*
Description of Job and Responsibilities*
Employer (2)
Address
Phone
Start Date
MM slash DD slash YYYY
Leave Date
MM slash DD slash YYYY
May we contact?
- Yes
- No
Job Title
Supervisor and Title
Reason for leaving
Description of Job and Responsibilities
Employer (3)
Address
Phone
Start Date
MM slash DD slash YYYY
Leave Date
MM slash DD slash YYYY
May we contact?
- Yes
- No
Job Title
Supervisor and Title
Reason for leaving
Description of Job and Responsibilities
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Phone
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James Monroe Wire and Cable Corporation
PO Box 1203, South Lancaster,
MA 01561

Phone: 978-368-0131
Fax: 978-368-1275

Or Call Toll Free
800-316-8877

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