| Equal access to programs and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department. |
Position applied for:
Last Name
First Name
Middle
Social Security #
Address
City
State
Zip
Telephone
Alternate Phone
Email
Referral Source (how did you hear about us)
If you are under 18, and it is required, can you furnish a work permit?
Yes
No
If no, please explain
Have you ever been employed here before?
Yes
No
If yes, give dates and positions
Are you eligible for employment in this country?
Yes
No
Date available for work
What is your desired salary range?
Type of employment desired?
Full Time
Part Time
Temporary
Seasonal
Educational co-op
Driver's licence number if driving may be required in position for which you are applying
D.L. #
State
Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation,
rehabilitation and position will be taken into account.
Have you ever Plead "guilty" or "no contest" to, or been convicted of a crime?
Yes
No
If Yes please provide date(s) and details
SKILLS & QUALIFICATIONS
Summarize any special training, skills licences and/or certificates that may assist you in performing the position for which you are applying
|
Computer Skills (check appropriate boxes. Including software titles and years experience)
|
QUESTIONNAIRE
|
Give me a brief overview of your career.
What do you like most about your current job?
What do you like least about your current job?
Why are you looking for another job?
Tell me about your most technically challenging experience.
Can you give me an example from a previous job when you had to develop a solution to meet a business need?
Describe a time when your performance data analysis had surprising results. What did you do?
Can you tell me about a time in your last job when you worked with others on a team? What was your role?
Can you describe a situation when you worked on a team that was struggling with a problem?
Describe a time when you had more to do than time to do it. How did you handle this?
Describe your most challenging customer relationship experience.
Give me an example of a time in your current job when you took initiative.
Tell me about a time when you followed corporate procedures even though you didn't agree with them.
Describe a time when you felt it was appropriate to skirt corporate procedures.
|
APPLICANT STATEMENT
|
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I expressly authorize, without reservation, the employer, 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 truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and with without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or 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 or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the forgoing express language are valid unless they are in writing and signed by the employer's president.
I also understand that 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 understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature of Applicant
Date
|
|