APPLICATION FOR EMPLOYMENT
(PRE-EMPLOYMENT QUESTIONNAIRE)   (AN EQUAL OPPORTUNITY EMPLOYER)
PERSONAL INFORMATION
Date :________________________

Social Security Number :________________________

Name : _____________________________________________________________________________________
Last                                                         First                                                              Middle

Present Address : _____________________________________________________________________________
Street                                                  City                                                    State                             Zip

Phone No : __________________________      Are you 18 years or older? Yes   No
Are you prevented from lawfully becoming emplyed in this
country because of visa or immigration status ?                   Yes   No
Employment Desired
Position Date you can start Salary Desired
Are you employed now? If so may we inquire of your present employer ?

Ever applied to this
company before?
Where? When?
Referred By   _____________________________________________________________________________

Education Name and Location of School * No of years attended * Did you graduate ? Subjects Studied
Grammar School        
High School        
College        
Trade Business or Correspondence School        
General
Subjects of special study or research work
____________________________________________________________________________________________
____________________________________________________________________________________________
Special Skills
____________________________________________________________________________________________
____________________________________________________________________________________________
Activities : (Civic, Athletic, etc)
____________________________________________________________________________________________
Exclude organizations, the name of which indicates the race, creed, sex, marital status, color or nation of orgin of its members.
____________________________________________________________________________________________
U.S. Military or Naval Service

Rank

Present Membership in National Guard or Reserves

*This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regualtions and interpretive guidance promulgated by the EEOC on July 26, 1991.



APPLICATION FOR EMPLOYMENT
FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST)
Date Month and Year Name and Address of Employer Salary Position Reason for leaving
From        
To
From        
To
From        
To
From        
To
Which of these jobs did you like the best?
What did you like most about this job?
References : Give the names of three persons not related to you, whom you have known at least one year
Name Address Business Years Acquainted
1)      
2)      
3)      
The following statement applies in: Maryland & massachusetts. (Fill in name of state)
It is unlawfull in the state of __________________________ to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability

________________________________________
Signature of Applicant

In case of emergency notify : _____________________________________________________________________________________________
Name                                                         Address                                                              Phone No

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice. At any time by the company. I understand that no company representative, other than it's president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing"

Date : ____________________    Signature ________________________













APPLICATION FOR EMPLOYMENT
Do not write below this line

Interviewed By                                                       Date :
Remarks :

Neatness :                                                            Ability :

Hired :      Yes      No:                                            Position                                                         Dept.:

Salary / Wage                                              Date Reporting to Work

Approved : 1                                                                                  2.                                                                3.
_________________________________________________________________________________________
                     Employment Manager                                                Dept.Head                                                General Manager


This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment Form is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and / or Federal Law.