Employment Application

All fields marqued with * are required !

Name and Address

• Application Date * Last Name * First Name * Middle Initial Street Address * City * State * Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• ZipCode * Home Phone * Alternative Phone Phone * E-mail Address * Emergency Contact * Relationship *

Position desired

• Position applied for * Full Time        Part Time  

  If part time, please list hours available:

  Salary Expected Date Available

• Are you available to work whatever schedule is necessary to help us meet our Corporate objectives and our obligations to our clients?     Yes     No

  If no, what shifts or days are you available?   

Personal Information

• Are you presently employed? :   Yes    No

  If yes, may we contact your present employer? :   Yes    No

  Do you have reliable transportation get to work each day?:   Yes    No

  To your knowledge, have you ever been employed by this Company or a subsidiary?:   Yes    No

  If Yes.Where? When?
• Position? Reason for Leaving?
• Referral source

  Walk In    Advertisement    Job Service    
  Employee Referral    Other

  If so, name the employee: 

Education

• THE FOLLOWING INFORMATION WILL BE USED ONLY TO THE EXTENT RELEVANT TO THE QUALIFICATIONS AND POSITION FOR WHICH YOU APPLY.

  Highest grade 1     2     3     4     5     6     7     8     9     10     11     12     13     14     15     16     +

  Do you have a high school diploma or GED?     Yes     No

  Did you earn a degree from college?     Yes     No

  If Yes, year awarded If Yes, Collage name Degree If Yes, year awarded

• Have you ever been convicted of, or pled guilty or "no contest" (nolo contendere) to, a misdemeanor or felony? (do not include minor traffic infractions for which you never appeared in court, offenses which were dismissed or discharged after completion of successful probation, and convictions or pleas which have been deemed sealed, annulled, or expunged by law)?   Yes ?   No
  If Yes, give details concerning the type of crime, the date of the conviction or plea, the penalty imposed, and any other circumstances you deem relevant to a full understanding of what occurred (attach additional sheets if necessary).
  NOTE: Answering "Yes" to this question is not an automatic bar to employment. Factors such as age at the time of the offense, seriousness, and nature of the violation, relatedness to the job sought, the amount of time which has passed since the event occurred, and evidence of rehabilitation will be taken into account. However, please be advised that a misstatement or omission in answering this question may be grounds for disciplinary action, including discharge.

• Have you been arrested or charged with any misdemeanor or felony not disclosed above for which you are out on bail or free on your own recognizance pending disposition or trial (again, do not include minor traffic infractions for which no court appearance is necessary)? ? Yes ? No
  If yes, give the date(s) and details of the arrest or charge and any other circumstances you deem relevant to a full understanding of what occurred (attach additional sheets if necessary).
  NOTE: Answering "Yes" to this question is not an automatic bar to employment. We will consider whether the circumstances of the arrest or charge substantially relate to the circumstances of the particular job sought, and other considerations allowed by law. Again, please be advised that a misstatement or omission in answering this question may be grounds for disciplinary action, including discharge.

• Have you ever been sued in a civil action with regard to the death of or personal injury or intentional damage to any person or to any property? ?     Yes      ? No
  If yes, give details concerning the nature of the claims and defenses raised by the parties, the outcome of the action (e.g., settlement, jury verdict, or other disposition), and any other circumstances you deem relevant to a full understanding of what occurred (attach additional sheets if necessary).

• Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?   Yes    No

• Are you currently engaged in using illegal drugs?    Yes    No

Work History

• Have you ever been granted a military or government security clearance?
       Yes     No   
  If yes, level of clearance:  

• Do you have any special job skills or qualifications that may be relevant to the position for which you are applying? If so, please describe:

List all employment, including military, for the past seven (7) years beginning with your present or last job held.

Refferences

Please list the names, addresses, and phone numbers of five people who are not related to you and who are not former employers

• Name and Occupation Address Phone

• 2.

  Name and Occupation Address Phone

• 3.

  Name and Occupation Address Phone

• 4.

  Name and Occupation Address Phone

• 5.

  Name and Occupation Address Phone

Understandings and Agreements

I understand that any misrepresentation, falsification or omission of this application shall be sufficient reason for refusal to hire or, if discovered after employment has begun, dismissal of my employment. I hereby authorize investigation of all matters contained in this application and agree that if the results of such investigation are not satisfactory, any offer of employment may be withdrawn, or, if applicable, my employment may be terminated immediately. I agree to conform to and adhere to the rules and regulations governing my employment. Further, I understand and agree that this application and any other materials I may receive are not intended to be, nor shall be construed to be a contract of employment, and that my employment and compensation may terminate, with or without cause, and with or without notice, at any time, at the option of either myself or my employer.

In consideration of any offer of employment, I hereby acknowledge, understand and agree that the following will constitute terms and conditions of any such employment:

Any losses or expenses incurred by my employer, its clientele, or other third parties as a result of my unauthorized actions shall be immediately reimbursed to my employer on terms that are satisfactory and acceptable to my employer. To the extent permitted by law, I agree and hereby authorize my employer to reduce my wages for any sums owing by me hereunder.