Employment Application

Name *

First

Last *

Last

Phone *

Email *

Current Address *

Street, City, State Zip

What position are you applying for? *

Are you eligible to work in the United States for any employer? *

Tell us why you're qualified *

Give us a short description of why you're qualified for this position.

Desired Salary *

Desired Work Hours *

Full-Time

Part-Time

Full or Part Time

Highest Education/Certification *

High School

Trade School

College/University

Professional Training

School/Institution *

Diploma/Degree/Certificate Awarded *

Have you ever been convicted of a crime? *

Yes

No

If Yes, explain number of convictions, type of offense, dates, and penalty.

Do you have a valid Driver's License? *

Yes

No

Please list the name of a personal reference, other than a relative or previous employer. *

Name of Reference 1

Reference 1 Relationship *

Friend, Co-worker, etc.

Reference 1 Phone # *

Reference 1 Email Address *

Please list the name of a second personal reference, other than a relative or previous employer. *

Name of Reference 2

Reference 2 Relationship *

Friend, Co-worker, etc.

Reference 2 Phone # *

Reference 2 Email Address *

Have you ever been in the Armed Forces? *

Yes

No

If YES, please list specialty, date entered and date discharged.

Please list work experience for the past five years. *

Name of Organization/Institution

Address *

Street, City, State, Zip

Date started & Date ended *

01/01/2001 - 01/01/2001

Please list job duties perfomed, skills used/learned and any advancements/promotions received. *

Please summarize the main reason you left or are looking to leave. *

Additional Place of Employment *

Name of Organization/Institution

Address *

Street, City, State, Zip

Date started & Date ended *

01/01/2001 - 01/01/2001

Please list job duties perfomed, skills used/learned and any advancements/promotions received. *

Please summarize the main reason you left or are looking to leave. *

May we contact your present/last employer? *

Yes

No

Did you complete this application yourself? *

Yes

No

If not, who did?

I can verify that all information entered is accurate and truthful, to the best of my knowledge. I understand that inoLECT will keep all data confidential. *

I agree

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