Application For QuikDine Employment

Pre-Employment Questionnaire
Equal Opportunity Employer

Personal Information

First Name:
Middle Initial:
Last Name:
Referred by:

Employment Desired

Position Desired:
Date you can start:
Salary Desired:
Are you currently employed?Yes | No
If so, may we inquire with your present employer?Yes | No
Have you ever applied to QuikDine?Yes | No
If so, where and when?

Education History

  Name & location of school Years Attended Did you Graduate? Subjects Studied
High School Yes
College Yes
Trade, Business or Correspondence School Yes

General Information

Subjects of special study/research work or special training/skills
U.S. Military or Naval Service

Former Employers

List below last four employers, starting with the last one first.

Start Date End Date Name and address of employer Salary Position Reason for leaving


Give below the names of three persons not related to you,
whom you have known at least one year.

Name Address Business Years known

“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 authorize investigation of all statements contained herein and the references and employers listed above to give 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 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.”