National Origin/CitizenshipAre you a U.S. Citizen? Where were you/your parents born? What is your "native tongue"?Are you authorized to work in the U.S.? What languages do you read or speak fluently? AgeHow old are you? When did you graduate from college? What is your birth date?Are you over the age of 18?If hired, can you show proof of age?Marital/Family StatueAre you married? Whom do you live with? Do you plan to have a family? When? Do you use birth control measures? How many children do you have? What are your child care arrangements?Would you be able to relocate if necessary? Are you willing and able to put in overtime/travel as needed by this job? (ok if all applicants are asked)PersonalHow tall are you? How much do you weigh? (ok if there are standards that are essential to performingthe job safely.)Are you able to lift a 70 pound box and carry it 25 feet repeatedly?DisabilitiesDo you have any disabilities? Please complete this medical history. Have you ever had surgery? How is your family's health? Have you ever received worker's compensation?Are you able to perform the duties of this job with or without reasonable accommodation? As part of the hiring process, you will undergo a full medical exam after a job offer has been made.Arrest RecordHave you ever been arrested? Have you ever been convicted of ____________? (ok if crime relates to performance of the job in question)MilitaryWere you dishonorably discharged from the Navy? When were you enlisted in the Army? Have you ever been in a foreign Armed Service? In what branch of the Armed Forces did you serve?· What special skills or training did you receive while enlisted?
