LAST
APPLICATION FOR EMPLOYMENT
(Pre-Employment Questionnaire) (An Equal Opportunity Employer)
PERSONAL INFORMATION
DATE
Name
Sebastian
LAST
16-Sep-91
Arifin
FIRST
MIDDLE
PRESENT ADDRESS Main Road, Block-A Shahjalal Upashahar, main Rd, Sylhet
STREET
CITY
STATE
ZIP
PERMANENT ADDRESS Main Road, Block-A Shahjalal Upashahar, main Rd, Sylhet
CITY
STATE
PHONE NO. +8801735328830
ARE YOU 18 YEARS OR OLDER?
FIRST
STREET
ZIP
Yes
No NO
EMPLOYMENT DESIRED
DATE YOU
CAN START
POSITION
IF SO MAY WE INQUIRE
ARE YOU EMPLOYED NOW? Yes
SALARY
DESIRED
EVER APPLIED TO THIS COMPANY BEFORE?
WHERE?
MIDDLE
OF YOUR PRESENT EMPLOYER? Staff India
WHEN?
REFERRED BY Rob (Headquqters 601 International House 223 Regent Street London, W1B 2QD United Kingdom)
EDUCATION
GRAMMAR SCHOOL
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR
CORRESPONDENCE SCHOOL
NAME AND LOCATION OF SCHOOL
*NO OF
YEARS
ATTENDED
Mohammedpur Govt. Primary School,
Sylhet, Banhgladesh
Adarsha High School, Sylhet, Bangladesh
5 years
Govt. Commercial Institute, Dhaka,
Bangladesh
Leading University, Sylhet, Bangladesh
2 Years
*DID YOU
GRADUATE?
SUBJECTS STUDIED
5 Years
4 Years
Accounting
Yes
Accounting Information
Systems
GENERAL
SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK
Diploma In Business Studies.
SPECIAL SKILLS Leadership, management skill, Planning, Organizing, Teamwork, Patient risk, Self-confident
ACTlVITIES: (CIVIC ATHLETIC ETC.)
EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED. SEX. AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.
U. S MILITARY OR
NAVAL SERVICE
RANK
PRESENT MEMBERSHIP IN
NATIONAL GUARD OR RESERVES
*This form has been revised to comply with the provisions of the Americans with Disabilities Act
and the final regulations and interpretive guidance promulgated by the EEOC on July 26. 1991.
TOPS FORM 3285 (92-8)
(CONTINUED ON OTHER SIDE)
LITHO IN U.S.A.
FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST).
DATE MONTH AND YEAR NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO
WHICH OF THESE JOBS DlD YOU LIKE BEST?
WHAT DlD YOU LIKE MOST ABOUT THIS JOB?
REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
NAME
ADDRESS
BUSINESS
YEARS ACQUAINTED
1
2
3
THE FOLLOWING STATEMENT APPLIES IN: MARYLAND & MASSACHUSETTS. [Fill in name of state.)
IT IS UNLAWFUL IN THE STATE OF
TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST
AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL
BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
IN CASE OF
Sebastian
Signature of Applicant
EMERGENCY NOTIFY
NAME
ADDRESS
PHONE NO.
"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT
IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND,
IF I AM EMPLOYED. MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.
IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT
MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE. AND WITH OR WITHOUT NOTICE, AT ANY TIME,
AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT
MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT
NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT,
HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY
AGREEMENT CONTRARY TO THE FOREGOING.
DATE
SIGNATURE
ING
