Energy Doctor Employment Application

Application For Employment		Pre-Employment Questionnaire Equal Opportunity Employer
For consideration of employment, please fill out all fields in the application and questionnaire sections. Application
Personal Information
First Name
Last Name
Date of Birth
Present Address
City
State		Zip:
Permanent Address		check if same as present
City
State		Zip:
Phone #
Referred By

Employment Desired
Position
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?
When?

Education History
Name & Location of School		Years Attended	Did You Graduate?		Subjects Studied
Grammar School		to	Yes No		N/A
High School		to	Yes No
College		to	Yes No
Trade, Business or Correspondence School		to	Yes No

General Information
Subjects of Special Study/Research Work or Special Training/Skills
U.S. Military or Naval Service
Rank

Former Employers (list below last four employers, starting with the last one first)
Date	Name & Address of Employer	Salary	Position		Reason For Leaving
To
From
To
From
To
From
To
From

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



Questionnaire
What image do you have of this company its industry? What type of products and services have you sold and how did you sell them? What type of books do you read? What self improvement classes or courses have you attended since leaving you formal education? Do you feel it is necessary to have written goals? Why or why not? Have you reached your full potential? if not how far do you have to go to be content? What is a career experience that demonstrates your work ethic? What is the biggest success in your career so far? How did you achieve that success, and were you able to repeat it? Could you teach others how to achieve the same results? Could you teach others how to achieve the same results? Are you meeting your goals currently? What is your reason for seeking opportunity elsewhere? Where do you see your career in 5 years? Describe in detail, including income level. What will your goals be? What, if any, would be a reason to leave that position? Imagine you are in complete control, and you could decide your position and income level, what would you choose? Describe in detail. "I certify that the facts contained in the 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 foregoing, 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." Date (mm/dd/yy) If you would like to include your resume, please check this box Please send your resume as an attachment to matt@energydoctorinc.com. What email address will you be sending your resume from? By checking this box, you verify that all the information above is accurate to the best of your knowledge

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