Moriroku Network  /  Greenville Technology Inc.  /  Anderson  /  Application
(Pre-employment Questionnaire)
(An Equal Opportunity Employer)
Personal Information
Full Name
Present Address
Permanent Address
Phone No.
Are you legally entitled to hold employment of the kind of which you are applying in the United States?
Have you ever been convicted of a felony or misdemeanor (other than minor traffic violations)?
If "yes", where and for what offense(s) were you convicted?
(A conviction will not necessarily be a bar to employment. Factors such as date, nature and number of offenses, age at the time of offense and rehabilitation will be considered.)
Employment Desired
Date you can start
Salary Desired
Are you employed now?
If so may we inquire of your present employer?
Have you ever applied to Greenville Technology, Anderson (GTI-A) before?
  Name and Location of School No. of Years Attended *Did you Graduate? *Subjects studied and Degree Received
*Degree of educational achievement is considered in the hiring process only to the extent that specific educational achievement is a requirement for performing the job.
List any additional special skills or abilities that you have which relate to the job for which you are applying
Former Employers List below last four employers, starting with last one first.
Date, Month & Year Name and Address of Employer Salary (Upon leaving) Position Reason for Leaving
References Give the names of three persons not related to you, whom you have known at least one year.
Name Address Position / Business Years Acquainted

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, incomplete, false, or misleading statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the 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 may result from furnishing same to you.

I also authorize you to obtain information regarding my record with the bureau of motor vehicles if the job for which i am applying will require driving as a part of my job duties.

I understand that pursuant to the company's job application process I may be required to undergo drug testing. I further understand that if I refuse to take or fail the drug test, I am disqualified from further employment consideration. I hereby knowingly and voluntarily consent to the company's request to undergo a drug test. I further release Greenville Technology, Inc. and its officers, agents, representatives and employees from any and all claims and liability for damages associated with or arising from my submission to the test.

In consideration of my employment, I agree to conform to company rules, regulations and policies, and agree that my employment and compensation can be terminated with or without cause, and with or without notice at any time, at the option of either the company or myself. I understand that no supervisor, manager, officer or representative of the company or any other entity, other than the president of Greenville Technology, Inc. has any authority to enter into any agreement for any specified period of time or to make any agreement contrary to the foregoing."