DIVERSITY - VUTEQ, LLC Employment Application

DIVERSITY - VUTEQ, LLC

Employment Application
Select your location:*
1. Applicants may be required to submit to drug and alcohol screening.

2. The information that you provide on this application is used in our search of applicant credentials for position vacancy requirements. Please be sure that your responses are complete and legible. PLEASE TYPE OR PRINT.

3. Uponrequest Diversity Vuteq, LLC will make reasonable accommodations to assist you in completing this application or participating in the application and interview process.

4. This application form must be completed in its entirety even though the information may be contained in your resume. Diversity Vuteq, LLC will not hire anyone who is simultaneously employed on a regular basis by another employer. Do not include extraneous information that is not specifically requested by this form. You will be disqualified from consideration if your answers on this application form are non-responsive, or if you include extraneous information.

5. Completing an application provides no assurance that you will be interviewed or hired.

6. Applications will be considered "active" for six (6) months, after which time a new application will be required for further consideration for vacancies.

7. It is the policy of Diversity Vuteq, LLC to provide equal opportunity in employment to all applicants and employees. No person will be discriminated against in employment because of race, gender, color, religion, national origin, veteran status or a mental or physical handicap, provided that the handicap does not prevent an individual from performing the essential functions of the job, with or without reasonable accommodation.
Background Information
Name*

First NameLast Name
Initial
Initial
Social Security Number*
Social Security Number
Address*

Current Address (Number & Street)

Street Address Line 2

City/StateState / Province

Zip Code
Home Telephone Number*
Home Telephone Number
Email Address
Email Address
Please indicate "YES" or "NO" to the following questions.
Have ever worked for or applied to Diversity Vuteq, LLC or its subsidiaries before? If yes, when?*

YesNo
If yes, when?
To
Are any of your relatives currently employed by Diversity Vuteq, LLC?*

YesNo
Are you legally eligible for employment in the United States?*

YesNo
Are you 18 years of age or older?*

YesNo
Have you been convicted of a felony? If yes please explain.*

YesNo
Are you willing to travel?*

YesNo
Position Information
Position Desired*
Date you can start*

MonthDayYear
Date
Desired salary or wage*
Please indicate all that apply in regards to the following items.
Employment desired:*

Full TimePart Time
Are you available:*

WeekendsHolidaysOvertime
What shifts are you able to work:*

FirstSecondThirdOther
Other shift availability
Are you currently employed?*

YesNo
May we contact your current employer?*

YesNo
How did you hear about us?

Educational Information

	School Name	City/State	Did you Graduate	Degree Earned
High School
College or University
Graduate School
Technical, Business, Military or other

Do you have a valid driver's license?*

YesNo
Have you previously signed a Nondisclosure or Non-Compete Agreement with your current employer?*

YesNo
Do you have any additional education, special training, degrees, certificates or other relevant experiences?*

YesNo
If yes, please explain
Personal References
Please list four (4) references that are not former employers or relatives.
Name*
Years Known*
Telephone Number*
Name*
Years Known*
Telephone Number*
Name
Years Known
Telephone Number
Name
Years Known
Telephone Number
Employment Experience

Please list your last four (4) employers, assignments, or volunteer activities, starting with the most recent. Please explain any gaps in employment. Additional sheets are available if necessary.
Employer*
Supervisor*
Telephone Number*
Address
From*
To*
Job Title*
Reason for Leaving*
Employer*
Supervisor
Telephone Number*
Address
From*
To*
Job Title*
Reason for Leaving*
Employer
Supervisor
Telephone Number
Address
From
To
Job Title
Reason for Leaving
Employer
Supervisor
Telephone Number
Address
From
To
Job Title
Reason for Leaving
If there are any gaps in employment please explain here:
READ CAREFULLY BEFORE SIGNING THIS APPLICATION

This organization is committed to the policy of equal employment opportunity in its personnel and employment practices. Your job-related experience and other qualifications will be considered without discrimination on the basis of religion, race, color, national origin, age, sex, height, weight, marital status, disability, military status, arrest record, or any other basis protected by applicable federal, state, or local law.

I understand that, in the event I am employed by the Company, I will be employed on an "at-will" basis, which means that the term of employment is not definite and that I may terminate my employment at any time, with or without cause, with or without prior notice, and that the Company retains the same right. The aforementioned constitutes the entire agreement between the Company and I on the subject of termination, layoff, and/or discharge and can only be changed by a written agreement signed and executed by the President of the Company.

I authorize investigation of all information contained in this application (and accompanying resume, if applicable I also authorize the Company to contact my present employer (unless otherwise noted in this application form), past employers, educational institutions, listed references, and any other agencies, institutions or persons to provide to you any information they have regarding me. I release from all liability, any persons, employer, or agency providing information pursuant to this authorization. I waive any right to written notice by my present or former employers that disclose information concerning me. I certify that the information provided in the Application is true and complete to the best of my knowledge. I understand that falsification or misrepresentation or any information on this or any other Company document will result in rejection of my application or termination of my employment if I become employed, regardless of the date the false or misleading statement is discovered.

I understand that, as a condition of any offer of employment, I am required by Federal law to produce documentary evidence of identity and authorization to work in the United States. If documents are not produced within 3 days of hire, employment will be delayed or terminated.

I agree to submit to a Drug and Alcohol screening test as a pre-condition to employment with Diversity Vuteq, LLC and understand that I will not be hired if I test positively for alcohol or controlled substances, unless that substance is due to a legitimate and verifiable prescription. Diversity Vuteq, LLC supports a drug-free working environment. I understand that the use of any drug or alcohol during working hours or an appearance of being under the influence of drugs or alcohol will result in immediate termination.

I understand that, as a condition to any offer of employment that I may receive, I will be required to undergo a Iunderstand that ofthe medicalrequiredallinsamejobemployment examinationcategory. enteringemployees offorwhichI the withLLCtotheessentialfunctionsposition Diversityisdependentonabilityperform Vuteq,my applying, with or without reasonable accommodation. I further understand that once employed I may be required to submit to medical examinations and/or inquiries that are job-related and consistent with business necessity.

I understand that the Company will make reasonable accommodations to assist me in completing this application, participating in the application/interview process, or, if hired, to perform essential elements of my job. I further understand that should I need any such accommodation, I must notify a Company representative within one hundred eighty-two (182) days after my need for accommodation is known, in order to preserve my rights under certain state laws.

Receipt of this application does not mean that a job opening exists at Diversity Vuteq, LLC and does not obligate Diversity Vuteq, LLC in any way. This application is valid for six (6) months from the date of application.

I acknowledge that I have read and understand this Application and have signed it voluntarily and of my own free will.
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

DIVERSITY - VUTEQ, LLC

Background Information

Position Information

Personal References

Employment Experience