Spencer, IA - Application for Employment

Application for Employment
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Today's Date

Month Day Year
Date
Date Available

Month Day Year
Date
Expected Income
Are you 18 years or older?

Yes No
Are you willing to relocate?

Yes No
Email
example@example.com

Education

School Name

City/State

Degree Obtained

Course of Study

High School

College or University

Business or Other Schooling

Have you worked under or been known by any other names?

Yes No
If so, list names:
Are you legally authorized to work in the United States?

Yes No
Is it OK to contact your current employer for a reference?

Yes No
U.S. Military Service - Training - Discharge
How did you hear about Employment Connections?
If someone referred you, please list their name.
Mark Areas of Experience
Administrative/Office Support

Administrative Assistant Bank Teller Bookkeeping Collections Customer Service Data Entry Office Manager Paralegal Receptionist Telemarketing Familiar with MS Excel Familiar with MS Word Familiar with QuickBooks
Manufacturing

Assembly Die Casting Distribution Food Processing Forklift Driver Inventory Clerk Line Supervisor Machine Operator Machinist - CNC Maintenance Material Handler Painter Production Quality Control Warehouse Welder
Trade Skills

Carpenter Construction Electrical Farming HVAC Landscape Maintenance Mechanic Millwright Plumbing Truck Driver
Professional

Accountant Architect Computer Networking Computer Programmer Educator Engineer Graphic Designer Human Resources Insurance Agent Marketing Purchasing Agent Safety Director
Service Industry

Cashier Cook Day Care Delivery Driver Food Service Hotel/Motel Janitorial Retail Sales Stocker
Other

General Labor Able to lift 25# Able to lift 50# Able to lift 75# Bilingual
If bilingual, list the languages you speak.
List any special skills or licenses.

References (no family members please)

Name

City

Phone

Relationship

Years
Acquainted

In case of an emergency, notify (name)
(address)
(phone)
Please read carefully before you commit to any assignment. Consider any doctor's appointments, legal matters, vacations, etc., before you commit.

Any assignment I accept, I agree to work through its duration. I also agree to notify Employment Connections, Inc. if I will be absent from work, and will give two weeks notice if I resign from a position.

I understand some clients of Employment Connections, Inc. require drug testing, criminal background checks, and/or driver license checks for insurance purposes as a condition for assignments at their sites. I authorize such tests and checks.

In submitting this application for employment, I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have. and release all parties from all liability for any damage that may result from furnishing same. It is understood and agreed that any misrepresentation (including omission of information) by me in this application will be sufficient cause for cancellation of the application and/or for separation from the company's service.

I also authorize Employment Connections, Inc. to provide a copy of my application to potential employers for the purpose of obtaining employment.
Signature of Applicant

Clear
Employment Connections, Inc. is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, military service, or national origin.

DISCLOSURE AND AUTHORIZATION FORM TO OBTAIN CONSUMER REPORTS FOR EMPLOYMENT PURPOSES

Please Read Carefully Before Signing the Authorization
DISCLOSURE
In considering you for employment and, if you are employed, in considering you for subsequent promotion, assignment, reassignment, retention, or discipline, Employment Connections, Inc. (hereafter referred to as EC/) may request and rely upon one or more consumer reports or investigative consumer reports about you that we obtain from a consumer reporting agency.

For explanation purposes:
- a "consumer report" is a written, oral or other communication of any information by a consumer reporting agency bearing on your creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in making an employment-related decision about you. Such information may include, for example, credit information, criminal history reports, or driving records; and
- an "investigative consumer report" is a consumer report in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your prior employers, neighbors, friends, or associates, or with others who may have knowledge concerning any such items of information. In the event an investigative consumer report is requested about you, you are entitled to additional disclosures regarding the nature and scope of the investigation requested, as well as a written summary of your rights under the Fair Credit Reporting Act ("FCRA").
Under the FCRA, before EC/ can obtain a consumer report or investigative consumer report about you for employment purposes, we must have your written authorization. Before we take adverse action on the basis, in whole or in part, of information in that report, you will be provided a copy of that report, the name, address, and telephone number of the consumer reporting agency, and a summary of your rights under the FCRA.
AUTHORIZATION
I have read and understood the foregoing Disclosure, and authorize EC/ to obtain and rely upon consumer reports or investigative consumer reports in considering me for employment and, if I am employed, in considering me for subsequent promotion, assignment, reassignment, retention, or discipline. By my signature below, I authorize EC/ to obtain any such reports and to share the information received with any person involved in the employment decision about me.

I hereby release and hold harmless from liability ECI and their representatives for seeking such information and all persons, corporations, and organizations for furnishing such information.
Signature

Clear
Date

Month Day Year
Date
Should be Empty:

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Application for Employment

Mark Areas of Experience

Additional Applicant Questions

DISCLOSURE AND AUTHORIZATION FORM TO OBTAIN CONSUMER REPORTS FOR EMPLOYMENT PURPOSES

DISCLOSURE

AUTHORIZATION