docClearTalk Employment Application 2012_REVS 10:31:12
download 
Report Transcription
ClearTalk Employment Application 2012_REVS 10:31:12
Applica6on for Employment This applica*on for employment is good for no more than 30 days. Considera*on for employment a9er 30 days requires a new applica*on. -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ Date: _________________ Posi,on applied for: ______________________________________ FT______ PT______ Date you can start: _______________________ Salary desired: ____________________ Have you filed an applica,on with ClearTalk before? ________ If so when? ___________ _____________________________________________________________________________________ PERSONAL: Name: _______________________________________________________________________________ Last First Middle Address: _____________________________________________________________________________ Number & Street City State Zip Code Phone: _____________________ Alternate: _____________________ Email: ___________________ Social Security Number: ________________________ Are you over 18 years old? ____________ Bilingual? ____ Yes ____ No Are you legally eligible for employment in the U.S.? ____ Yes ____ No (If offered employment you will be required to provide documenta,on to verify eligibility). _____________________________________________________________________________________ EDUCATION: Please indicate educa,on or training which you believe qualifies you for the posi,on you are seeking. High School: Yrs. completed (circle one) 1 2 3 4 Diploma: ____Yes ____No G.E. D. ____ Yes ____ No High School(s) aZended: _____________________________ City/State: ________________________________________ College and/or voca,onal school: Yrs. completed (circle one) 1 2 3 4 School(s) aZended: _________________________________ City/State: __________________________ Major(s) _________________________________ Degrees earned: ______________________________ School(s) aZended: _________________________________ City/State: __________________________ Major(s) _________________________________ Degrees earned: ______________________________ Other training or cer,fica,ons: 1 of 5 Applica6on for Employment School(s) aZended: _________________________________ City/State: __________________________ Course(s): ____________________________________________________________________________ Degree or cer,ficate earned: _____________________________________________________________ _____________________________________________________________________________________ RECORD OF CONVICTIONS OR SEXUAL ABUSE ACCUSATIONS: During the last ten years, have you ever been convicted of a crime other than a minor traffic offense? ____ Yes ____ No If yes, explain: _________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ (A convic,on will not necessarily automa,cally disqualify you for employment. Such factors as age and date of convic,on, seriousness and nature of the crime, and rehabilita,on will be considered.) Have you ever been accused of any type of sexual abuse? ____ Yes ____ No. If the answer is “Yes”, state the nature of the accusa,on and the result of the inves,ga,on thereof. __________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ EMPLOYMENT: List last employer first, including the U.S. Military. May we contact your present employer? ____ Yes ____ No If any employment was under a different name, indicate name: _________________________________ Employer: ______________________________ Address: ______________________________________ Phone: _____________________ Posi,on: ___________________________________ Dates of employment: From: _______ To: _______ Mo/Yr Mo/Yr Salary: ______________ Supervisor: ______________________ Department: ______________________ Du,es: _______________________________________________________________________________ FT____ PT ____ Hours worked per week: _____________________ Reason for leaving: _____________________________________________________________________ Employer: ______________________________ Address: ______________________________________ Phone: _____________________ Posi,on: ___________________________________ Dates of employment: From: _______ To: _______ 2 of 5 Applica6on for Employment Mo/Yr Mo/Yr Salary: ______________ Supervisor: ______________________ Department: ______________________ Du,es: _______________________________________________________________________________ FT____ PT ____ Hours worked per week: _____________________ Reason for leaving: _____________________________________________________________________ Employer: ______________________________ Address: ______________________________________ Phone: _____________________ Posi,on: ___________________________________ Dates of employment: From: _______ To: _______ Mo/Yr Mo/Yr Salary: ______________ Supervisor: ______________________ Department: ______________________ Du,es: _______________________________________________________________________________ FT____ PT ____ Hours worked per week: _____________________ Reason for leaving: _____________________________________________________________________ Employer: ______________________________ Address: ______________________________________ Phone: _____________________ Posi,on: ___________________________________ Dates of employment: From: _______ To: _______ Mo/Yr Mo/Yr Salary: ______________ Supervisor: ______________________ Department: ______________________ Du,es: _______________________________________________________________________________ FT____ PT ____ Hours worked per week: _____________________ Reason for leaving: _____________________________________________________________________ Explain any gaps in work history: __________________________________________________________ Have you ever been discharged or asked to resign from a job? ____ Yes ____ No If yes, explain: _________________________________________________________________________ _____________________________________________________________________________________ 3 of 5 Applica6on for Employment REFERENCES: Professional: Personal: Name: ________________________ Address: _______________________ _______________________________ Name: ________________________ Address: _______________________ _______________________________ Phone: ( ) ______________________ Phone: ( ) ______________________ Professional: Personal: Name: ________________________ Address: _______________________ Address: _______________________ _______________________________ _______________________________ Phone: ( ) ______________________ Phone: ( ) ______________________ Professional: Personal: Name: ________________________ Address: _______________________ Address: _______________________ _______________________________ _______________________________ Phone: ( ) ______________________ Phone: ( ) ______________________ Name: ________________________ Name: ________________________ 4 of 5 Applica6on for Employment APPLICANT STATEMENT I cer6fy that the informa6on I have provided on this applica6on is true and complete. I understand that any false informa6on I provide could result in dismissal or removal from considera6on for employment. I authorize Flat Wireless, LLC to contact and obtain any informa6on necessary to verify the data I provided within this applica6on. I waive any and all rights and claims I may have against Flat Wireless, LLC if they obtain and use such informa6on in the employment process and any other persons who may furnish such informa6on about me. I understand that employment with Flat Wireless, LLC is “at will” which means that I will be free to resign at any 6me, with or without prior no6ce, and that Flat Wireless, LLC reserves the same right to terminate my employment at any 6me, with or without cause and without prior no6ce, except as may be required by law. This applica6on does not cons6tute an agreement or contract for employment for any specified period or definite dura6on. I understand that no supervisor or representa6ve of the employer is authorized to make any assurances to the contrary and that no implied oral or wriXen agreements contrary to the foregoing express language are valid unless they are in wri6ng and signed by the employer’s chief execu6ve officer. I understand that I must present proof of iden6ty and authority to work in the United States within three days of my start date and that I must successfully pass the company’s background check and drug test in order to qualify for employment with Flat Wireless, LLC ______________________________ Signature ______________________________ Print Name ______________________________ Date Flat Wireless, LLC is an Equal Opportunity Employer. 5 of 5
