Office Solutions Employment Application
Last Name:
First Name:
Middle Intial:
Telephone No:
Email Address:
Present Address:
City:
State:
Zipcode:
Permanent Address:
City:
State:
Zipcode:
Were you ever employed by us:
Yes
No
If so, please provide period(s) employed and position(s) held:
Have you ever served in the military:
Yes
No
How did you learn about us?
Job Interest
Department of Interest:
Position or type of Work Desired:
Second Choice:
Work schedule desired:
Full Time
Part Time
Temporary
Date available to begin work:
Wage or salary desired:
Are you willing to relocate:
Yes
No
Are you willing to travel:
Yes
No
Are you willing to work extra hours, weekends and evenings:
Yes
No
Personal
If you plead guilty, no contest, had a suspended imposition of sentence, or have been convicted of any felony, please describe each: (convictions are not necessarily a reason for exclusion from consideration from employment)
Please describe:
Are you at least 18 years old:
Yes
No
Provide ONLY the information requested in this employment application form. Failure to do so will result in disqualification of your application.
Education
Name & Location
No. of Years Completed, Graduated?
Grade
Major Field of Study
Minor Field of Study
Scholastic Standing GPA
High School
College
University
Business, Technical, Other
Scholastic honors, scholarships, assistantships, awards, publications, etc.
Employment History- List Most Recent Employer First
Company Name:
Company Address:
Dates Employed (From-To)
Job Title
Wage/Salary
Reason for leaving:
Supervisors's Name:
Supervisors's Title:
Telephone:
May we contact:
Yes
No
Provide a brief description of your work and responsibilities:
Work Experience 2:
Company Name:
Company Address:
Dates employed (to-from)
Job Title:
Wage/Salary:
Reason for leaving:
Supervisor's Name:
Supervisor's Title
Telephone:
May we contact:
Yes
No
Provide a brief description of your work and responsibilities:
Work Experience 3
Company Name:
Company Address:
Dates Employed (to-from)
Job Title:
Wage/Salary:
Reason for leaving:
Supervisor's Name:
Supervisor's Title:
Telephone:
May we contact:
Yes
No
Provide a brief description of your work and responsiblities:
Special Skills
Computer Applications:
Professional Registrations:
Other Skills:
Adding Skills
Calculator
Dictation Equipment
Data Entry
Shorthand
Typing WPM:
Please list any other applicable skills:
Activities
List Organizations of which you are a current or former member: (Membership in religious, ethnic or foreign organizations will not be used for purposes of discrimination)
High School and College Activities (include if applicable, office or position held)
Professional & Technical Organizations (include if applicable, office or position held)
Civic and Recreational Activies:
References:
Please list three personal references whom we may contact:
Name:
Telephone No:
Address:
Name:
Telephone No:
Address:
Name:
Telephone No:
Address:
Applicant Statement and Acknowledgement
I certify that, to the best of my knowledge, the information given in this application and any attachments are true and correct. I understand that any incorrect, incomplete, false or misleading statement, answer or information will subject my application to disqualification from further consideration, or if employed, may subject me to termination of employment. I hereby agree that the Company may investigate my qualifications with previous employers, personal references and other background security or criminal conviction records. If employed, I agree to executive a confidentiality/assignement of invention agreement, in consideration of such employment. I understand my employment with the Company is terminable at-will and would not be for any fixed period of time, and I may resign at any time for any reason or the Company may terminate my employment at any time for any reason with or without notice, and that this application is not and is not intended to be a contract for continued employment. I understand that according to law all individuals who are hired must as a condition of employment produce certain documentation to verify their legal authorization to work in the US. As a consequence, I understand that offer of employment, (and contined employment) would be contingent on my ability to produce the required documentation within the time period required by law. I have read and understand all of the provisions of this statement and acknowledgment. By signing this application, I hold the Company harmless from any results of the reference check. I hereby authorize and release from liability all former employers, educational institutions, law enforcement agencies or other governmental agencies to provide or release information regarding my employment, education, criminal conviction record, credit history, drivers license and motor vehicle records that may be in their possession, to the Company or its agents. I further understand that an offer of employment (and continued employment) is conditioned upon several criteria, including my satisfactorily passing certain laboratory test (including test for substance abuse) which may be required by the Company.
By typing my name I have read and understand the applicant statement and acknowledgement:
Date:
Submit Form
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