Employment Application Please fill out the form below to create your job application. Contact Information: Name: Email: Telephone: Position Information Position Applied For: Choose...Accounting/HRAdmin/ExecutiveClient ServicesData ScienceOps/ConsultingPaid Search/Social MediaSEO/Web Date Available: Desired Salary: Personal Information Are you a US Citizen? YesNo Have you ever worked for this company? YesNo If yes, when? Do you have a reliable means of transportation to and from work? YesNo Are you at least 18 years old? If under 18, hire is subject to verification that you are of minimum legal age. YesNo If hired, can you present evidence of you US citizenship or proof of your legal right to live and work in this country? YesNo Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation YesNo If no, describe the functions that cannot be performed 0 / 300 Social Security Number: Education High School Name: From: To: Did you graduate? YesNo Did you receive a GED? GED College: From: To: Did you graduate? YesNo Degree/Diploma: Trade School/Other: From: To: Degree: References Please list three professional references Full Name: Relationship: Company: Phone: Full Name: Relationship: Company: Phone: Full Name: Relationship: Company: Phone: Previous Employment Company Phone: Supervisor: Job Title: From: To: Responsibilities: 0 / 300 Reason for Leaving: Yes, you may contact my previous supervisor for a reference Company Phone: Supervisor: Job Title: From: To: Responsibilities: 0 / 300 Reason for Leaving: Yes, you may contact my previous supervisor for a reference Military Service If not applicable, click "Next" Branch: From: To: Rank at Discharge: Type of Discharge: If not Honorable/General discharge, explain: Disclaimer & Signature Please read carefully and initial each paragraph. I certify that the information provided by me in this application is true and complete to the best of my knowledge. I understand that if I am employed, any material false statements or omissions will lead to immediate dismissal, and I agree that the Agency shall not be held liable in any respect if my employment is terminated, or if I am no longer considered for employment for that reason. I understand that this Application for Employment and other Agency documents are not contracts of employment. You are hereby authorized to verify the information I have supplied and to conduct any investigation of my personal history and/or credit and financial records, employing investigative or credit agencies or bureaus of your choice subject to the provisions of the Fair Credit Reporting Act. I understand that, within a reasonable period, I may make a written request for detailed information concerning such an investigation. I authorize the companies, schools, and persons named above to give any information requested regarding my employment, character, and qualifications, and release and hold harmless (employer) and the companies, schools, and persons from any liability. I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time without prior notice and without cause, at the option of either myself or the Agency, and that no promises or representations contrary to the foregoing are binding on the Agency unless made in writing and signed by me and the Agency. I further understand that any offer of employment may be conditioned upon the results of a background check, drug test, and/or integrity test. I waive a receipt of a copy of any public record described in the paragraph above. Type your name here to sign: Date: PreviousNext **If you need additional room for any section, please email a separate document to [email protected] include your name and position applying for in the subject line
