Online Application Form

PERSONAL INFORMATION (* required fields)

First Name:

*

M.I.:

Last Name:

*

Address:

*

City:

*

State:

*

Zip:*

Home Phone:

*

Cell Phone:

Email:

*

POSITION DESIRED

Position:

*

Industry Preference:

*

Salary:

Hourly Rate:

# of Hours per week:

Location:

Other:

Size of Company:

*

Available Start Date:

*

WORK HISTORY

Most Recent History

Start Date:

End Date:

Company Name:

City

State:

Job Title:

Supervisor:

Supervisor's Phone:

Salary:

Bonus/Overtime:

Total Compensation:

Reason for Leaving:

Previous Employment

Start Date:

End Date:

Company Name:

City:

State:

Job Title

Salary:

Bonus/Overtime:

Total Compensation:

Reason for Leaving:

Next Previous Employment

Start Date:

End Date:

Company Name:

City:

State:

Job Title:

Supervisor:

Supervisor's Phone:

Salary:

Bonus/Overtime:

Total Compensation:

Reason for Leaving:

EDUCATION

High School:

City:

State:

Graduation Date:

College:

City:

State:

Degree or Certificate:

Graduation Date:

Other:

City:

State:

Degree or Certification:

Graduation Date:

SKILLS

Skills

*

Microsoft Word	Microsoft Excel
Microsoft Access	Microsoft Outlook
Microsoft Project	Microsoft Publisher
Microsoft PowerPoint	Lotus 1-2-3
Lotus Notes	Dictaphone
Windows XP	Quickbooks
Peach Tree	Quicken
ACT	Data Entry

Typing (wpm)

Steno (wpm)

Other: (seperate by commas)

GENERAL INFORMATION

Have you ever been terminated or asked to resign from any job?

*

Yes

No

If yes, please explain:

Have you ever been convicted of a misdemeanor or felony? A "conviction" includes a plea, verdict or finding of guilt regardless of whether sentence was imposed by the court. Do not include: (1) minor traffic infractions; (2) convictions related to marijuana that occurred more than two years ago; (3) convictions which have been judicially sealed, expunged, or statutorily eradicated; (4) misdemeanor convictions for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed; and (5) any information concerning a referral to, and participation in, any pretrial or post trial diversion program.

NOTE: Answering "Yes" to this question does not necessarily disqualify you from employment.

Must Select whether you have been convicted

*

Yes

No

If yes, please explain:

Are you legally able to be employed in the United States:

*

Yes

No

Must select whether you have the right to work in the United States

VERIFICATION/REFERENCE CHECK AUTHORIZATION

I hereby affirm that all information given by me on this application is true and complete, If my answers are untrue or misleading, you have the right to dismiss me immediately. If selected for employment, I agree to provide documentation showing that I am authorized to work in the U.S. You may contact my former employers for references and release information herein to your clients. My employment may be terminated by you at any time, and you will only be liable to me for wages earned up to termination. If I work for you, I will be your employee. I will obtain permission before discussing permanent employment with your clients. I will keep confidential all information I learn from your clients.

By checking this box, I hereby acknowledge that I have read, understand and agree to the foregoing.

*

Yes

No

Attach Resume:

SIGNATURE: _______________________