Brick Staining Technology, Inc

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Brick Staining Technology, Inc. Employment Opportunities

Application for Employment

Pre-Employment Questionnaire
Equal Opportunity Employer

Personal Information Date
Name (Last Name First)
Present Address
Zip Code
Permanent Address
Zip Code
Phone No
Referred By
Employment Desired
Date you can start
Salary Desired
Are you Employed? Yes No If so, may we inquire of your present employer?
Yes No
Ever Applied To This company Before? Yes No Where?
Education History
Name and Location of School Years Attended Did You Graduate? Subjects Studied
Grammar School

Yes No

High School

Yes No


Yes No

Trade, Business or
Correspondence School

Yes No

General Information
Subjects of Special Study/Research Work or Special Training/Skills:
Valid Driver's License?
U.S. Military or Naval Service
Former Employers (List below last four employers, starting with last one first)
Date Month and Year Name & Address of Employer Position Reason For Leaving
From To
From To
From To
From To
References (Give below the names of three persons not related to you, whom you have known at least one year)
Name Address Business Years Known
"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 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 employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."
Yes No Signature

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