Serving Michigan since 1985
4 Star Inc.
6689 Orchard Lake Road Suite 357
West Bloomfield, MI 48322

Tel: 248.924.2568
Fax: 248.924.2569
Direct: 248.361.7599

Pre-Employment Questionnaire | An equal opportunity employer

Personal Information

  Date: ____/____/_____
Name: Last: First: Middle: SSN: ____--___--_____
Present Address: Street: City: State: Zip:
Permanent Address: Street: City: State: Zip:
Phone Number: ( _____ )_____-_________ Are you 18 Years of age or older?  
Are you either a US Citizen or an alien authorized to work in the United States? Yes / No

Employment Desired

Position __________________ Date you can Start __________________ Salary Desired __________________
Are you currently Employed? ____ Yes / No _____ If yes, may we inquire of your present employer? ________
Ever Applied to this company before? _______________ Where? _______________ When? _______________
Referred By: ___________________________________

Education Name and Location of School No. of Years Attended Did you Graduate?

Subjects Studied?

Grammar School

High School        

Trade/Business or Correspondence School



Subjects of Special Study or Research Work: _______________________________________________________________
Special Skills: ________________________________________________________________________________________
Activities: (Civic, Athletic, etc.) _________________________________________________________________________
(Exclude organizations whose name indicates the race, creed, sex, age, marital status, color or nation or origin of its members)
U.S. Military or Naval Service ______________Rank_______Present membership In national guard or reserves__________

FORMER EMPLOYERS (List below the last 3 employers, starting with the most recent first)

Date (Month/Yr) Name Address of Employer Salary Position Reason for leaving?

Which of those jobs did you like best? ___________________________________________________________
What did you like best about this job? ___________________________________________________________

REFERENCES - Provide the name of three persons not related to you, whom you have known at least one year.

Name Address Business Years Acquainted

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.

Signature of Applicant

In Case of Emergency Notify:

Name ______________________________ Address ______________________________ Phone _________________


In submitting this application, I certify that the facts and information contained in the application are true and complete to the best of my knowledge. I understand that any incorrect, incomplete or falsified statements or information provided on this application may be grounds for denial of employment or immediate dismissal.

I authorize investigation of all statements contained herein. I authorize all past employers and all references 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 all parties from all liability for any damage that might result from furnishing same to you.

DATE ____________________ SIGNATURE _____________________________________


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Interviewed By______________________________________DATE___________________
SALARY/WAGE____________________DATE REPORTING TO WORK______________