Bullseye Industries, Inc. - Job Opportunity

Bullseye Industries, Inc.

Pre-Employment Questionnaire
(An Equal Opportunity Employer)

General Employment Application

Personal Information

Name (Last, First, MI):
Present Address:
City, State, Zip Code:
Permanent Address: if different than above address
Phone Number:
Email Address:
Are you 18 years or older?	YES NO
Social Security #: no dashes please
Are you either a U.S. Citizen or an Alien authorized to work in the U.S.?	YES NO

Position Applied For

Basic Information

Job Title:
Date you can Start:
Desired Salary/Wage:
Currently Employed?	YES NO
If so may we inquire your present employer?	YES NO

Where did you hear about this job opening?
Internet Job listing Newspaper Radio Advertisement Word of Mouth
Other
** I am willing to work...
Check all that apply Full time Part time Day time Evening Overtime
Will you accept temporary employment?
Yes No
Have you ever worked for/applied to Bullseye Industries, Inc. before?
Yes No
If Yes, please state WHEN:

Educational Background

Schools attended

	Name/Location	Graduated		# of years completed	Degree Received
	Name/Location	Yes	No	# of years completed	Degree Received
High School
College
Post-Graduate
Other

Prior Employment

1st Employer Information

Name and Location of Employer:
Position:
Reason for Leaving:
Name of Supervisor :
Employer Phone Number:
Start Date:
End Date:

2nd Employer Information

Name and Location of Employer:
Position:
Reason for Leaving:
Name of Supervisor :
Employer Phone Number:
Start Date:
End Date:

3rd Employer Information

Name and Location of Employer:
Position:
Reason for Leaving:
Name of Supervisor :
Employer Phone Number:
Start Date:
End Date:

(Resume) Attachment

Confirmation

By typing your **initials in the box below, you agree that all information provided is to the best of your knowledge. If hired by Bullseye Industries, Inc., any false information in this document may be cause for termination.

**Initials:

462 W. Kindt Street, Juneau, WI 53039, 920-386-4625