EuroTan USA

Application For Employment

Pre-Employment Questionnaire An Equal Opportunity Employer

Phone 360.604.0333

www.EuroTanUSA.com

Former Employers

List below your last four employers with the most recent one first.

Name of present or previous employer ____________________________________________

Address ___________________________________City __________________ State_______

Starting Date _____________ Leaving Date ________________ Job Title ________________

Starting Salary ______________________ Final Salary_____________________

Name of Supervisor ___________________________ Title___________________________

Phone Number_________________________ May we contact your supervisor? ___Yes___No

Description of work and responsibilities ___________________________________________

___________________________________________________________________________

Reason for Leaving? __________________________________________________________

Name of present or previous employer ____________________________________________

Address ___________________________________City __________________ State_______

Starting Date _____________ Leaving Date ________________ Job Title ________________

Starting Salary ______________________ Final Salary_____________________

Name of Supervisor ___________________________ Title___________________________

Phone Number_________________________ May we contact your supervisor? ___Yes___No

Description of work and responsibilities ___________________________________________

___________________________________________________________________________

Reason for Leaving? __________________________________________________________

Name of present or previous employer ____________________________________________

Address ___________________________________City __________________ State_______

Starting Date _____________ Leaving Date ________________ Job Title ________________

Starting Salary ______________________ Final Salary_____________________

Name of Supervisor ___________________________ Title___________________________

Phone Number_________________________ May we contact your supervisor? ___Yes___No

Description of work and responsibilities ___________________________________________

___________________________________________________________________________

Reason for Leaving? __________________________________________________________

Name of present or previous employer ____________________________________________

Address ___________________________________City __________________ State_______

Starting Date _____________ Leaving Date ________________ Job Title ________________

Starting Salary ______________________ Final Salary_____________________

Name of Supervisor ___________________________ Title___________________________

Phone Number_________________________ May we contact your supervisor? ___Yes___No

Description of work and responsibilities ___________________________________________

___________________________________________________________________________

Reason for Leaving? __________________________________________________________

REVISED 08.27.2003

2 of 4

© 2003 - 2007  EuroTan USA. All rights reserved. Page re design by Northern-Consulting.com