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PRE-INTERVIEW QUESTIONNAIRE
Smart Park, Inc.
900 E. 2nd St.
Essington, PA 19029
Fax: 610-521-3500
Email:
positions@smartpark.com
Expresspark South, Inc.
55 Industrial Highway Essington, PA 19029
Fax: 610-521-0300
Email:
positions@expresspark.net
(Pre-employment Questionnaire)
(An Equal Opportunity Employer)
Personal Information
Date
Date
MM slash DD slash YYYY
Name
*
First
Middle
Last
Present Address
Street Address
Street Address
Address Line 2
Address Line 2
City
City
State
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip Code
Zip Code
Phone Number
*
Phone Number
Are you 18 Years or Older?
Are you 18 Years or Older?
Yes
No
Are you Either a U.S. citizen or an alien authorized to work in the United States?
Are you Either a U.S. citizen or an alien authorized to work in the United States?
Yes
No
EMPLOYMENT DESIRED
Position
Position
Driver
Cashier
Start
Start
Salary Desired
Salary Desired
Are you employed now?
Are you employed now?
Yes
No
Inquire of your present employer
Inquire of your present employer
Yes
No
Ever applied to this company before?
Ever applied to this company before?
Yes
No
Where?
Where?
When?
When?
Referred By?
Referred By?
U.S. Military or Naval Service?
U.S. Military or Naval Service?
Yes
No
Rank
Rank
Present Membership in National Guard or Reserves
Present Membership in National Guard or Reserves
Yes
No
*The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age
FORMER EMPLOYERS (List below last three employers, starting with last one first)
From
From
MM slash DD slash YYYY
To
To
MM slash DD slash YYYY
Name and Address of Employer
Name and Address of Employer
Salary
Salary
Position
Position
Reason for leaving
Reason for leaving
From
From
MM slash DD slash YYYY
To
To
MM slash DD slash YYYY
Name and Address of Employer
Name and Address of Employer
Salary
Salary
Position
Position
Reason for leaving
Reason for leaving
From
From
MM slash DD slash YYYY
To
To
MM slash DD slash YYYY
Name and Address of Employer
Name and Address of Employer
Salary
Salary
Position
Position
Reason for leaving
Reason for leaving
Which of these jobs did you like best?
Which of these jobs did you like best?
What did you like most about this job?
What did you like most about this job?
DRIVERS RECORD INFORMATION: (DRIVERS ONLY)
Driver's License #:
Driver's License #:
State:
State:
Birthdate
Birthdate
Expiration Date:
Expiration Date:
Classes:
Classes:
Endorsements:
Endorsements:
Issue Date:
Issue Date:
Medical Restrictions:
Medical Restrictions:
Insurance Company’s name and address for your personal vehicle
Previous Driving Experience
Previous Driving Experience
Yes
No
If you circled yes, what type?
If you circled yes, what type?
School Bus
Shuttle Van
Taxi
Ambulance
Public Transportation Vehicle
Tractor-Trailer
Other
Other (Please describe)
Other (Please describe)
What shift would you prefer?
What shift would you prefer?
Part-time
Full-time
Weekdays
1st Shift
2nd Shift
3rd Shift
Only Certain Days (choose all that apply)
Only Certain Days (choose all that apply)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday