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	Hydco, Inc.

Application For Employment

(Pre-Employment Questionnaie)		(An Equal Opportunity Employer)

PERSONAL INFORMATION
First Name Middle Initial Last Name

Email Address

Present Address

City State Zip

Permanent Address

City State Zip

Telephone Number Call or Message Number

Are you 18 years of age or older? Yes No

Special Questions
Do not answer ANY of the questions in this framed area unless the employer has CHECKED or HIGHLIGHTED a question. Thereby indicating that the information is required for a bona fide occupational qualification, or dictated by national security laws or is needed for other legaly permissible reasons.

Height - feet Height - Inches Weight - lbs.

Are you prevented from lawfully becoming employed in the US? Yes No

Date of Birth*

What Foreign Languages do you speak fluently?
Read Yes No Write Yes No

Have you been convicted of a felony or misdemeanor with the last 5 years?**
Yes No If yes, please describe

*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.
**You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.

EMPLOYMENT DESIRED
Position Date you can start

Salary desired $ per hour/month/annual

Are you employed now? Yes No
If so, may we inquire of your present employer? Yes No

Ever applied to this company before? Yes No
Where When

EDUCATION	School	Location	Graduate?	# of years	Subjects Studied
Grammar School
High School
College
Trade/Bus.
Other

GENERAL

Subjects of special study or research work (please list)

U.S. Military or Naval Service YES NO Rank

Present Membership in National Guard or Reserves

Do you have reliable transportation? YES NO

FORMER EMPLOYERS (list below last four employers, starting with last one first)

Name of Employer Address City State Zip Dates (month/year)From To Reason for leaving

Name of Employer Address City State Zip Dates (month/year)From To Reason for leaving

Name of Employer Address City State Zip Dates (month/year)From To Reason for leaving

Name of Employer Address City State Zip Dates (month/year)From To Reason for leaving

REFERENCES (Give the name of three persons not related to you, whom you have known at least one year.)

Name Address
Business Years Known

Name Address
Business Years Known

Name Address
Business Years Known

PHYSICAL RECORD
Do you have any physical limitations that preclude you from performing any work for which you are being considered? Yes No
If yes, please describe

In Case of emergency notify:

Address Phone No.

"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 understand that if I quit or leave my employment with Hydco, Inc. within 30 days of hire for reasons other than being terminated, the
cost of my drug test will be withheld from my final payroll check. The drug test cost is $35.00.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of date of payment of my wages and salary,
be terminated at any time without prior notice."

Date