Employment Application

Employment Application
Position Applying For
Type of Employment
How did you hear about this position?
Referred By
Personal Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Are you legally entitled to work in the United States?

YesNo
Education
Secondary School Attended (Name,City,State)
Highest Grade Completed
College or University Attended (Name, City, State)
Degree
Other Educational Training/Courses/Certifications
References
Reference #1 - Name

First NameLast Name
Reference #1 - Relationship to You
Reference #1 - Phone Number
Please enter a valid phone number.
Reference #2 - Name

First NameLast Name
Reference #2 - Relationship to You
Reference #2 - Phone Number
Please enter a valid phone number.
Employment History
Employer 1
Employer Name
Phone Number
Please enter a valid phone number.
Your Position/Title
Immediate Supervisor
Date of Hire

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Reason for Termination
Employer 2
Employer Name
Phone Number
Please enter a valid phone number.
Your Position/Title
Immediate Supervisor
Date of Hire

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Reason for Termination
Employer 3
Employer Name
Phone Number
Please enter a valid phone number.
Your Position/Title
Immediate Supervisor
Date of Hire

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Reason for Termination
MAY WE CONTACT YOUR PRESENT OR MOST RECENT EMPLOYER FOR A REFERENCE?

YesNo
PLEASE READ CAREFULLY
Merchants Acceptance Corp. will not discriminate against any employee or applicant for employment because of race, color, creed, religion, sex, national origin, age, marital status, veteran status, sexual preference or disability.

I hereby certify that to the best of my knowledge and belief the answers given by me to the foregoing questions and all statements made by me in the application are correct.

If employed, I agree that all material created and produced whether in written, graphic or broadcasting form, all inventions new or changes in processes developed during my employment are the exclusive property of the company to use and/or sell and that subsequent to my employment with this company I will not disclose, use or reveal any confidential information related to the company without first obtaining written consent from an officer of the company.

I hereby apply for employment upon the basis and understanding that such employment is at-will and may be terminated at any time upon notice given to me personally or sent to my last known address.

I consent to Merchants Acceptance Corp. obtaining personal records, background checks, past and/or current job-related information as required in connection with verifying information in order to gain employment.
Signature

Clear
Date

MonthDayYear
Date
Upload Cover Letter - Optional

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Upload Resume - Optional

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Employment Application

Personal Information

Education

References

Employment History

Employer 1

Employer 2

Employer 3

PLEASE READ CAREFULLY