EMPLOYMENT APPLICATION        PRE - EMPLOYMENT  QUESTIONNAIRE
                                                                EQUAL  OPPORTUNITY  EMPLOYER

PERSONAL INFORMATION:
NAME: (LAST NAME FIRST)
SOCIAL SECURITY NUMBER:
PRESENT ADDRESS:
CITY:
STATE:
ZIP:
PHONE NUMBER:
ALTERNATE PHONE NUMBER:
REFERRED BY:
PERMANENT ADDRESS:
CITY:
STATE:
ZIP:
EMPLOYMENT DESIRED:
POSITION
DATE YOU CAN START:
SALARY DESIRED:
ARE YOU EMPLOYED?
IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?
EVER APPLIED TO THIS COMPANY BEFORE?
WHERE?
WHEN:
EDUCATION HISTORY:
NAME AND LOCATION OF SCHOOL:
GRAMMAR SCHOOL:
HIGH SCHOOL:
COLLEGE:
TRADE/CORRESPONDENCE/BUSINESS SCHOOL:
YEARS ATTENDED:
DID YOU GRADUATE?
GENERAL INFORMATION:
SUBJECTS OF SPECIAL STUDY RESEARCH WORK OR SPECIAL TRAINING/SKILLS.

US MILITARY SERVICE:
RANK:
FORMER EMPLOYERS:  LIST BELOW LAST (4) EMPLOYERS STARTING WITH LAST ONE FIRST
1. NAME OF EMPLOYER
2. ADDRESS
3. DATE/MONTH/YEAR EMPLOYED
4. SALARY
5. POSITION
6. REASON FOR LEAVING


"BOX WILL EXPAND AS INFORMATION IS ENTERED"
REFERENCES:
GIVE BELOW THE NAME OF (3) PERSONS NOT RELATED TO YOU, WHOM YOU KNOWN FOR AT LEAST 1 YR
1. Name
2. Address
3. Phone:
4. Business
5.Years known
AUTHORIZATION:
"I CERTIFITY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HERIN AND THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE. PERSONAL OR ORTHERWISE AND RELEASE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.
I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYEMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGHNED BY AN AUTHORIZED COMPANY REPRESENTATIVE.
THIS WAIVER DOES NOT PERMIT THE RELEASE OR USE OF DISIBILITY- RELATED OR MEDICAL INFORMATION IN A MANNER PROHIBITED BY THE AMERICANS DISABILITY ACT (ADA) AND OTHER RELEVANT FEDERAL AND STATE LAWS."
SIGNATURE:
DATE:
MUST CLICK ON SUBMIT BUTTON TO SEND APPLICATION
TO CLEAR ALL INFORMATI0N AND RESTART CLICK ON RESET BUTTON
INTERVIEWED BY:
HIRED DATE:
POSITION:
SALARY/WAGES
MANAGER APPROVAL SIGNATURE:
THIS BELOW SPACE IS FOR GSI ONLY. 
Glass Systems, Inc. 6655 Marbut Road Lithonia Georgia, 30058  (770) 482-5232
DATE:
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO