Assist Services Application for Employment

Assist Services Application for Employment
In order that your application may be properly evaluated, it is essential that all of the following questions to answered carefully and completely. Feel free to attach a supplement to this application if necessary. If you require assistance or accommodation in completing this application or regarding any aspect of the interview process, please contact Human Resources.

Assist is an equal opportunity employer. No question on this application is asked for the purpose of limiting or excluding any applicant's consideration for employment because of race, color, religion, sex, ancestry, national origin, place of birth, marital status, veteran status, disability or other legally protected status. All information will be treated confidentially.
Position applied for*
Check one*

Full timeTemporaryPart time
Date

MonthDayYear
Date
Full Name*
Email*
example@example.com
Present address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone (home)
Please enter a valid phone number.
Telephone (cell)*
Please enter a valid phone number.
Last 4 digits of social security number*
Date of availability*

MonthDayYear
Date
Are you at least 18 years old?*

YesNo
Are you legally eligible to work in the United States?*

YesNo
Salary expectations*
Do you have any relatives of acquaintances employed by Assist or its affiliates?

YesNo
If yes, please list their names, their department, and their relationship to you

Education
High School
School name and city
Course or major area
Years completed
Certificate or degree
College
School name and city
Course or major area
Years completed
Certificate or degree
Graduate
School name and city
Course or major area
Years completed
Certificate or degree
Business
School name and city
Course or major area
Years completed
Certificate or degree
Trade
School name and city
Course or major area
Years completed
Certificate or degree
Other
School name and city
Course or major area
Years completed
Certificate or degree
Significant details of highest level of education (include such items as degree, major field of concentration, scholastic honors, publications, professional societies, extracurricular activities, other training (seminars, company training programs, etc.)

References
Name
Address
Phone Number
Please enter a valid phone number.
Phone
Relationship
Occupation
Years known
Do you wish to add another reference?

YesNo
Name
Address
Phone Number
Please enter a valid phone number.
Phone
Relationship
Occupation
Years known
Do you wish to add another reference?

YesNo
Name
Address
Phone Number
Please enter a valid phone number.
Phone
Relationship
Occupation
Years known

If you feel that there is anything we should know about you or your past work history, please provide details here:
Professional certifications, accomplishments and activities (include memberships and participation in professional or technical organizations, papers published, patents, etc.)
Emergency Contact Information
Name
Address
Phone
In the space below, give any other information you desire concerning your work experience, education, accomplishments, etc.
This application remains active for one year.

Please read carefully before signing.

I hereby affirm that my answers to the foregoing questions are true and correct. I authorize this company to conduct whatever investigation it deems necessary to confirm the answers submitted on this application. If investigation determines any untrue answer was made, I accept this as sufficient ground for immediate dismissal.

I also authorize any of my former employers to furnish Assist with their record of my services, my reason for leaving their employ, and any other information they may have concerning me. I hereby release any of my former employers from all liability for any damages in furnishing said record.

I agree that if I am employed by Assist, a full transcript of my records as an employee, including reason for termination, may be given to a prospective employer on this request, and do hereby release Assist from any and all liability or damages whatsoever in furnishing such information.

I agree to abide by the rules and policies of Assist. I further understand that all applications are subject to a drug screening as a condition of employment. Screenings are conducted at a facility designated by Assist at Assist's expense.

I understand and agree that my employment is for no definite period and may, regardless of the period of payment of wages or salary, be terminated at any time for any reason whatsoever without any previous notice. I further understand that no company official has made any promises to the contrary or guaranteed me employment for any specified period of time, and that no employee handbook or policy may be construed to the contrary or interpreted as a contract or guarantee of employment.

The use of this application form does not indicate that there are any positions available, and in no way obligates Assist Services, LLC.
Applicant signature*

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Date

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Date
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Assist Services Application for Employment

Education

High School

College

Graduate

Business

Trade

Other

Employment History

Military Service

Security Clearance

References

Emergency Contact Information