Essentials Superstore

PRE-EMPLOYMENT QUESTIONNAIRE

Note: Completion of this form is to evaluate applicant’s suitability for a vacant position. It is
not an employment contract.

1. PERSONAL INFORMATION:

Position Applied For: (required)

Surname: (required)

Other Names: (required)

Residential Address: (required)

Telephone Number(s): (required)

Email Address: (required)

Spouse Name:

Spouse Telephone Number:

2. PARENT INFORMATION:

Father’s Name: (required)

Telephone Number: (required)

Residential Address: (required)

Mother’s Name: (required)

Telephone Number: (required)

Residential Address: (required)

Please indicate (By selecting Alive or Not Alive) if they are alive at the time of this application

Father:(required)—Please choose an option—AliveNot Alive
Mother: (required)—Please choose an option—AliveNot Alive

3. NEXT OF KIN INFORMATION:

Name: (required)

Residential Address: (required)

Telephone Number: (required)

Relationship: (required)

4. EDUCATIONAL QUALIFICATIONS:

School:

Certificate Obtained:

Date:

School:

Certificate Obtained:

Date:

School:

Certificate Obtained:

Date:

School:

Certificate Obtained:

Date:

School:

Certificate Obtained:

Date:

5. RELEVANT PROFESSIONAL QUALIFICATIONS:

Organization:

Certificate Obtained:

Date:

Organization:

Certificate Obtained:

Date:

Organization:

Certificate Obtained:

Date:

Organization:

Certificate Obtained:

Date:

6. WORKING EXPERIENCE:

Current

Company/Organization’s Name (required):

Address (required):

Email Address (required):

Telephone (required):

Designation (required):

Period of Employment (FROM) (required):

Period of Employment (TO) (required):

Would you allow Supply Chain Global Services Ltd. to contact the organization
concerning your record of employment? (required)

YesNo

Immediate Past

Company/Organization’s Name:

Address:

Email Address:

Telephone:

Designation:

Period of Employment (FROM):

Period of Employment (TO):

Would you allow Supply Chain Global Services Ltd. to contact the organization
concerning your record of employment?

YesNo

Past

Company/Organization’s Name:

Address:

Email Address:

Telephone:

Designation:

Period of Employment (FROM):

Period of Employment (TO):

Would you allow Supply Chain Global Services Ltd. to contact the organization
concerning your record of employment?

YesNo

7. REFEREES:

Name: (required)

Contact Address: (required)

Telephone Number: (required)

Email: (required)

Relationship: (required)

Name: (required)

Contact Address: (required)

Telephone Number: (required)

Email: (required)

Relationship: (required)

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