TPG Portal System

Application for Employment

This is a pre-employment questionnaire. The Pour Guys, LLC is an Equal Opportunity Employer.

The token for your application is 594bed918d985. Please make note of this token in case you need to update your application at a later time.

Date of application: Jun 22 2017, 12:17 pm EDT

Personal Information

First name

Middle name

Last name

Social Security No.

Present address

City

State

Zip

Permanent address

City

State

Zip

Phone

Are you 18 years or older?

Yes
No

Are you prevented from lawfully becoming employeed in this country because of visa or immigration status?

Yes
No

Employment Desired

Position

Date you can start

Salary desired

Current employer

May we inquire of your present employer?

Yes
No

Have you ever applied to TPG before?

Yes
No

If so, when?

Do you have reliable transportation?

Yes
No

Referred by

Can you perform the essential functions of the job you are applying for with or without reasonable accomodation?

Yes
No

Education/Military Service

Grammar school name

Grammar school location

No. of years attended

Did you graduate?

Yes
No

High school name

High school location

No. of years attended

Did you graduate?

Yes
No

College name

College location

No. of years attended

Did you graduate?

Yes
No

Subjects studied in college

Special skills

United States Military Service and Rank

References

Provide the name of three persons not related you, whom you have known at least one year:

Reference #1

Name

Address

City

State

Zip

Phone

Business

Years aquainted

Reference #2

Name

Address

City

State

Zip

Phone

Business

Years aquainted

Reference #3

Name

Address

City

State

Zip

Phone

Business

Years aquainted

Former Employers

List below last three employers, last one first:

Employer #1

From

Name

Address

City

State

Zip

Phone

Salary

Position held

Reason for leaving

Employer #2

From

Name

Address

City

State

Zip

Phone

Salary

Position held

Reason for leaving

Employer #3

From

Name

Address

City

State

Zip

Phone

Salary

Position held

Reason for leaving

Which of these jobs did you like best?

What did you like most about this job?

Emergency Contact

Please list the name and phone number of nearest relative, neighbor, or person to contact in the event of an emergency:

Name

Phone

Relationship

Certification and Authorization

“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 Pour Guys, LLC rules and policies, 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 option or The Pour Guys, LLC 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 authorize schools, references, and prior employers to provide my record, reason for leaving employment, and all other information they may have concerning me to The Pour Guys, LLC and I release all parties providing information from any and all liability or claims for damages whatsoever that may result from this information’s release and use."

By entering your full name below, you acknowledge that you have read the above Certification and Authorization and agree to its terms:

Signature

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