Equal access to programs, services and employment is available to all persons. Those applicants requiring accomondations to the applocation and/or interview process should contact a representative of the Personnel Department.
Full Name Position(s) applied for Address Phone Number Email Date of Birth If you are under 18 can you furnish a work permit? Date available to work Have you ever been employed by ProList? Are you legally eligible for employment in the U.S.? Type of employment desired Are you able to meet the attendance requirements of the position? Have you been convicted of a crime in the last 7 years? If yes, please explain Drivers licence number (if job related) Employment History
List your last three (3) employers, assignments, or volunteer activities, start with the most recent, including military experience.
Employer #1 Job Title Address Supervisor Start Date End Date Summarize the nature of the work preformed and job responsibilities Reason for leaving Starting Hourly Rate/Salary Final Hourly Rate/Salary Employer #2 Job Title Address Supervisor Start Date End Date Summarize the nature of the work preformed and job responsibilities Reason for leaving Starting Hourly Rate/Salary Final Hourly Rate/Salary Employer #3 Job Title Address Supervisor Start Date End Date Summarize the nature of the work preformed and job responsibilities Reason for leaving Starting Hourly Rate/Salary Final Hourly Rate/Salary Skills and Qualifications Please include any information that would pertain to your requested position Education and Background High School College Other References Please provide information on three (3) professional references. Include contact name, company, title, and phone or email information. How did you hear about us? Electronic Signature of Applicant Date signed Referred by
It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information, and all other persons, corporations or organizations for furnishing such information. The employer is an Equal Opportunity Employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law. This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. I understand it is this company’s policy not to refuse to hire a qualified individual with a disability because of this person’s need for an accommodation that would be required by the ADA.