Imler's Employment - General Employment

 

PRE-EMPLOYMENT QUESTIONAIRE
Equal Opportunity Employer



In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability.


*ALL FIELDS MUST BE COMPLETED
 
* Name:
* Email Address:
*Today's Date:
* Social Security No.
 

Present Address:

 
* Street
* City:
* State:
* Zip:
* Phone Number
* How Long?
 

Permanent Address:

 
* Street
* City:
* State:
* Zip:
* How Long?
 
* Position Applied For:
* Date you can start:
* Rate of pay expected:
 
* Are you currently employed? Yes
No
   
* If so, may we contact your present employer? Yes
No
   
* Have you ever applied to this company before? Yes
No
* If so, when? ( if none write NA )
 
Do you have either a highschool diploma or a G.E.D.? Yes
No
*Last School Attended
 
**EMPLOYMENT HISTORY**

List below last four employers, starting with the last one.

 
 
Employer (Start with most recent)   Date (mm/dd/yy)
* Name: From:
* Address: To:
* City, ST ZIP:  
* Position Held: Wage:
* Contact Name: Phone:
* Reason for leaving? ( if not applicable write NA )
 
 
Employer   Date (mm/dd/yy)
* Name: From:
* Address: To:
* City, ST ZIP:  
* Position Held: Wage:
* Contact Name: Phone:
* Reason for leaving? ( if not applicable write NA )
 
 
Employer   Date (mm/dd/yy)
* Name: From:
* Address: To:
* City, ST ZIP:  
* Position Held: Wage:
* Contact Name: Phone:
* Reason for leaving? ( if not applicable write NA )
 
 
Employer   Date (mm/dd/yy)
* Name: From:
* Address: To:
* City, ST ZIP:  
* Position Held: Wage:
* Contact Name: Phone:
* Reason for leaving? ( if not applicable write NA )
 
DO YOU HAVE A HISTORY OF A MISDEMEANOR CONVICTION? Yes
No
   
DO YOU HAVE A HISTORY OF A FELONY CONVICTION? Yes
No
 
(Note: No applicant will be denied employment solely on the grounds of a misdemeanor or felony conviction.)
If yes to either of the above two questions, please explain below:
If none, write NA
 
**REFERENCES**

Give the names of 3 persons not related to you,
whom you have known at least 1 year.

 
Reference 01
*Name:
*Address
*Phone
*Years Known
   
Reference 02
*Name:
*Address
*Phone
*Years Known
   
Reference 03
*Name:
*Address
*Phone
*Years Known
 
AUTHORIZATION

"I certify 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 herein 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 otherwise, and release
the company from any 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 employment
for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an
authorized company representative."

 
*Applicant Name:  
 
**Additional Information**
 
*Use this box to include any additional information that you think would help us in the decision to offer you employment. (If none, write NA)
 
Clicking this button and submitting this application certifies that this application was completed by me, and that all entries on it and
information in it are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
 
A * indicates a field is required
 

 



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

Established in 1903, Imler's Poultry is headquartered in Duncansville, Pennsylvania. The company services both retail and foodservice customers throughout the Eastern United States. Imler's customer base includes many National Accounts and their customers are serviced through Imler's privately owned transportation company.

Imler's Poultry

1887 Route 764 ● Duncansville, PA 16635
P.O. Box 836 ● Duncansville, PA 16635

(814) 943-5563 ● (800) 446-5377

 

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