Employment Application

APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

Instructions: Please print all information and complete every part of this application. If there is a question which does not apply to you, mark "N/A." Do not leave any question unanswered. Any false, misleading, or incomplete responses may result in disqualification for hire or immediate dismissal from employment. You may add another page if necessary. This application will be kept on file for consideration for 30 days, at which time it will expire. You are welcome to submit a new application at that time. Please let us know if you are in need of any reasonable accommodation in the application process.

Position applied for:

Today's Date:

Date you can start:

How did you learn about this job?

PERSONAL INFORMATION

First Name

Middle Name

Last Name

Other Name(s) Used:

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Home Phone

Other Phone

Are you avaliable:

Full Time

Part Time

Temporary

Please describe any work schedule limitations:

Have you applied a for job with us before?

Yes

If yes, state date:

Have you been employed by us before?

Yes

If yes, state date and jobs:

Do you have relatives employed by us?

Yes

If yes, list the relatives:

Have you ever been convicted of a felony, or of any crime relating to theft or dishonesty, or involving acts of violence?

Yes

If yes, please explain:

NOTE: A criminal record will not necessarily disqualify an applicant from employment. The circumstances of the conviction will be considered in relation to the nature and duties of the job

Are you authorized to be employed in the United States?

Yes

NOTE: The law requires that you provide evidence and a sworn statement of your citizenship or work authorization if you are hired. Any offer of employment which you receive is contingent upon your providing the documentation and statement which we will request from you.

PRIOR EMPLOYMENT

List your last three jobs, beginning with the most recent (you may omit jobs held more than five years ago).

May we contact your current employer?

Yes

Employer 1:

Employer Name

Job Title

Duties

Address

Dates Employed

Salary

Phone

Reason for Leaving

Employer 2:

Employer Name

Job Title

Duties

Address

Dates Employed

Salary

Phone

Reason for Leaving

Employer 3:

Employer Name

Job Title

Duties

Address

Dates Employed

Salary

Phone

Reason for Leaving

EDUCTION AND TRAINING

Name and location of high school

Graduated?

Yes

Please list technical or trade school, college, and post-graduate education, if any:

Institution 1:

School/College

Degree

Level Completed

Major Subjects

Institution 2:

School/College

Degree

Level Completed

Major Subjects

Institution 3:

School/College

Degree

Level Completed

Major Subjects

VETERAN STATUS

If you are a veteran of the armed forces of the United States, please the following information:

Military Branch:

Rank at Time of Discharge:

Training/Work Experience Received:

OTHER SKILLS

Describe any special skills including computer, tool, equipment or office machine skills and proficiency level:

List all professional affiliations and / or licenses or certificates held which are relevant to the position applied for, including state, license or certificate type, date issued, and license or certificate number:

REFERENCES

Please list three references whom we can contact.

Reference 1:

Name:

Relationship:

Phone:

Occupation:

Years Known:

Reference 2:

Name:

Relationship:

Phone:

Occupation:

Years Known:

Reference 3:

Name:

Relationship:

Phone:

Occupation:

Years Known:

By signing below, I certify that the answers and information set out above are true, accurate and complete to the best of my knowledge. I acknowledge that if any answer or information is not true, accurate or complete, I may not be hired, or if hired, I may be discharged. I authorize The Alliance Group, Inc (Alliance) / Client Company, or its agents, to investigate all statements contained in this application for employment and to investigate my character and qualifications. I authorize my prior employers, references, and others with information regarding my work or educational history or my character, to provide Alliance / Client Company, or its agents, with all requested information and references, and to cooperate fully with the investigation of my character and qualifications.

I understand that this application is not a contract of employment. I also acknowledge that no oral representations have been made, and that no one within Alliance / Client Company has the authority to make oral contracts of employment. If hired, my employment relationship with Alliance / Client Company is terminable at-will, with or without cause, by either myself or Alliance / Client Company.

I also understand that any offer of employment may be conditional upon my passing a pre-employment physical examination and drug/alcohol test administered by a health care professional selected by Alliance / Client Company to which I hereby consent.

I understand and agree to all of the conditions and statements set forth above, and throughout this application.

We are an equal opportunity employer. Employment opportunities are open to all qualified applicants solely on the basis of their job-related experience, knowledge, skills and abilities. Qualified applicants are considered for all open positions for which they apply and for advancement without regard to race, color, religion, gender, sexual orientation, national origin, age, marital status, or the presence of a medical condition or disability. The Company complies with all applicable federal, state and local laws with regard to equal employment opportunity. Advancement is based entirely on an individual's demonstrated performance, job-related ability, skills and knowledge and the resulting potential for promotion to the job openings applied for.

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