Employment Application
Equal access to programs, services and employment opportunities is available to all persons without regard to race, color, religion, age, sex (including pregnancy, sexual orientation, and gender identity), national origin, disability, genetic information, or any other basis protected by federal, state, and/or local law. In accordance with the Americans with Disabilities Act and/or applicable state and local laws.
For what position(s) would you like to apply?
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Collection Specialist
Administrative Professional
Applicant Name
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First Name
Last Name
Applicant Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Applicant Phone Number
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Format: (000) 000-0000.
Applicant Email
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example@example.com
How were you referred to us?
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Walk-In
Employee Referral
Facebook
LinkedIn
Flier
QR Code
Other (please specify)
How were you referred?
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Who may we thank for referring you?
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Employment Eligibility
Date Available for Work
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/
Month
/
Day
Year
Date
Have you submitted an application here before?
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Yes
No
Are you lawfully authorized to work in the United States?
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Yes
No
Have you entered into an agreement with any former employer or other party (such as noncompetition agreement) that might, in any way, restrict your ability to work for our company?
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Yes
No
Employment Preferences
What is your desired salary range or rate of pay?
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Type of employment desired
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Full-Time
Part-Time
Reasonable Accommodation
Are you able to perform the “essential functions” of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
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Yes
No
Need more information about the job’s “essential functions".
Criminal Background
Have you ever been bonded?
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Yes
No
Have you ever pleaded “guilty” or “no contest” to or been convicted of a crime? NOTE: Answering “yes” to this question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. You are not obligated to disclose convictions that have been discharged under Georgia's First Offender Law.
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Yes
No
If yes, please provide the date(s) and details:
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Employment History
Please start with your current or most recent employer if not currently employed
Employer Name
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Employer Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Employer Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you currently employed here?
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Yes
No
Start Date
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/
Month
/
Day
Year
Date
End Date
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/
Month
/
Day
Year
Date
Immediate Supervisor and Title
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Name
Title
Reason for Leaving
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Summarize the nature of work performed and job responsibilities
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Would you like to add another employer?
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Yes
No
Employer Name
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Employer Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Employer Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
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/
Month
/
Day
Year
Date
End Date
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/
Month
/
Day
Year
Date
Immediate Supervisor and Title
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Name
Title
Reason for Leaving
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Summarize the nature of work performed and job responsibilities
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Would you like to add another employer?
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Yes
No
Employer Name
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Employer Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Employer Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
*
/
Month
/
Day
Year
Date
End Date
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/
Month
/
Day
Year
Date
Immediate Supervisor and Title
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Name
Title
Reason for Leaving
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Summarize the nature of work performed and job responsibilities
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Would you like to upload a resume?
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Yes
No
Resume
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Upload a File
Drag and drop files here
Choose a file
Cancel
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What special skills, experience and/or training would enhance your ability to perform the position for which you've applied?
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Education
Select all that apply
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Some High School
High School Diploma
GED
Some College
College Degree
High School name, location, and graduation date (If applicable)
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School, location, and date awarded GED
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College name, location, and subjects studied / major
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References
Please list two (2) references that are familiar with your work life.
Reference One Name
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First Name
Last Name
Reference One Email
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example@example.com
Reference One Phone
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Please enter a valid phone number.
Format: (000) 000-0000.
Reference Two Name
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First Name
Last Name
Reference Two Email
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example@example.com
Reference Two Phone
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Please enter a valid phone number.
Format: (000) 000-0000.
Please read carefully before signing.
I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Carter-Young to hire me. If I am hired, I understand that either Carter-Young or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Carter-Young has the authority to make any assurance to the contrary. I attest with my signature below that I have given to Carter-Young true and complete information on this application. No requested information has been concealed. I authorize Carter-Young to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
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Please verify that you are human
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Submit Application
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