Employment Application Form

Internal Info

Owner: Paul Dimayuga
Data Retention: Annual
Form Expiration: None
Last updated: 12/1/2022
External URL: http://apply-test.nxlperformance.com
Employment Application
Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
E-mail Address:*
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Position Applying for:*
I have reviewed the job description for the position I am applying for and I affirm that I can perform the essential functions of the position with or without reasonable accommodation.*
Department
How were you referred to us?*

Walk-InEmployee ReferralLinkedInIndeedOther (please specify)Friend/Relative Referral
Name of Referral
Others:
Have you ever completed an application here before?

YesNo
If so, when?

MonthDayYear
Date
Are you employed now?

YesNo
If so, may we contact your present employer?

YesNo
Are you prevented from lawfully becoming employed in this country because of Visa or immigration status?

YesNo
On what date would you be available for work?

MonthDayYear
Date
Are you on a layoff and subject to recall?

YesNo
Can you travel if the job requires it?

YesNo
If yes, please explain
Indicate language you, speak, read, and or write:
Language 1:

We may conduct a check of your references. Please sign below indicating your consent that we may conduct a reference check which will include, but not be limited to contacting previous employers, confirming title, and position.

Check to acknowledge
We may conduct a check of your references. Please sign below indicating your consent that we may conduct a reference check which will include, but not be limited to contacting previous employers, confirming title, and position.

Clear

References Please list three (3) references that are familiar with your work life.
Reference 1
Name:

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Years Known:
Reference 2
Name:

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Years Known:
Reference 3
Name:

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Years Known:
I certify that the answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment.

I understand it is the policy of Dittman Incentive Marketing DBA Next Level Performance that all employees are employed at will. At will employment means that my employment may be terminated at any time, without cause or notice, by either me or the Company.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
Please draw the symbol below to prove you are not a robot*
Should be Empty: