Employment Application For: ADMINISTRATIVE

The policy of our company in all aspects of its operation is that each person will be considered solely on the basis of qualifications, without regard to race, color, sex, religion, national origin, age, disabilities or veteran status.  We do accept resumes and cover letters, but we require completion of our on-line application. All applications must be completed at this website. 

* Required Fields - Please do not use symbols in these fields (", ', / % etc...sample O'Toole should be entered as O Toole)
Date :  9/4/2010 3:29:58 PM
(Name As it Appears On Social Security Card) Last Name: *  First Name: *
Home Phone: - -  
Email:

Present Address:  

Street:  City:  State:

Zip Code:
Social Security Number (Optional): - -               Are you over age 18? Yes    No
Currently employed?  Yes No
When can you start?
Are you a smoker?
Are you authorized to work in the U.S. for any employer?   Yes   No

Have you ever been convicted of, plead guilty to, or served probation for any crime (excluding minor traffic
violations including DWI)? Yes  No

If yes, state the offense, location, date and disposition 
NOTE: A conviction will not necessarily disqualify you from employment.

Do you have obligations or other reasons that would limit your ability to travel or work overtime?

         Yes  No

If yes, please explain:

Would you be willing to relocate? Yes No
Drivers License: (for drivers only) State Type

Employment Desired:

Are you seeking full-time part-time temporary or summer employment

Position applied for Salary desired *  Per Hour Per Year
Have you applied for our company before? Yes No
Have you worked for our company before? Yes No

If your answer to either of those questions is yes, please state when and where you applied and/or worked.

How did you learn of our company and/or position?
Are there any reasons why you would be unable to perform the tasks involved in the position that you are applying for?
Yes   No If yes, please state reasons
Education: 

Name and Location

   

Courses Studied

High School:

  Graduate?

City:     State:
College: Graduate?

City:    State:
Trade School: Graduate?

City:     State:
Please provide us the name of the person or recruiter who referred you to our organization.:

Work History: 

Begin with your most recent or current employer (including military experience) and list your previous employers for at least the last 10 years (we have allowed for quite a few blocks for employer information. DO NOT leave any gaps in employment history even for periods of unemployment.

Prior to an offer of employment being extended, your current and past employers as well as your references will be contacted.  Please click in the following box, if you prefer we not contact your current employer until after an offer of employment (and this offer will be contingent on a positive response from your current employer).

(Click on Add More Lines on the bottom for more entry space) 

 

Please Be Brief and Accurate

 (Please do not reference your resume.)

Enter Last Job 
First (06/02)

Former Employer's Name 

Nature of Business

Pay Rate

Job Title  

Job Duties

Brief Reason For 
Leaving

Supervisor

From:  
To:   

From:  
To:   

From:  
To:   

          
  Give Three References, Not Relatives or Former Employers

Name

Address

Phone

Please Paste or Type Your Resume Below (Limit to 4000 Characters)

 

I, the undersigned applicant, certify that all information I have provided to apply for and secure work with our company is true, complete and correct.  Further, I understand that successful completion of a criminal background check and drug test are conditions of my employment or continued employment should a job offer be extended prior to results of these checks.  In addition, depending on the position, a credit history check may be run and my employment or continued employment, should a job offer be extended prior to the results of this check, is dependent on the outcome of this check.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect and at any time, will be sufficient cause to cancel further consideration of this application, or immediately discharge me from employment (regardless of tenure), whenever this incorrect information is discovered.

I expressly authorize, without reservation, our company, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview.  I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.  If there are organizations or individuals you do not want us to contact, list in the following space: 

Please do not use symbols in this field (", ', / % etc...)

    

(please type in your initials acknowledging understanding of the preceding paragraph -->> )*

I understand the company does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable Local, State or Federal law.  I understand this application remains current for 30 days and only for the position(s) I indicated on the first page. At the conclusion of this 30-day period, if I have not heard from our company and still want to be considered for employment, I will need to reapply by completing a new application.

If I am hired, I understand I am free to resign my position at any time, with or without cause and without prior notice, and our company reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law.  This application does not constitute an agreement or contract for employment for any specified period of definite duration.  I understand no supervisor or representative of the company is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the President of our company.

I also understand if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that Federal immigration laws require me to complete an I-9 form in this regard.

I have read and understand the preceding statements. I understand the company uses Electronic signature and agreed that when I click the Submit Application button below, I have consented to the use of the electronic signature method to sign this employment application. ( I understand I can revoke this electronic signature method at anytime by submitting the request in writing and faxing it to the HR office).  

(Print this application for your record by using the printer function on your browser. For best result, set print function to landscape.)
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