Executive Assistant to the President & CEO

Full Name*

First NameLast Name

Phone Number*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

Confirmation Emailexample@example.com

Are you over the age of 18?*

YESNO

Are you eligible to work in the United States?*

YESNO

Have you applied here before?*

YESNO

If yes, give date:*

Position you are applying for

Date available for work*

Date

Have you been convicted of a felony/misdemeanor (other than traffic violations)?*

YESNO

If so, provide the location, date and result/outcome for each conviction:*

WORK HISTORY

Upload your resume, click Choose File*

ADDITIONAL INFORMATION

List job-related accomplishments, projects, and awards that you would like us to consider.

List any additional information you would like us to consider:

REFERENCES

List four professional references, (chuch, business or work, not relatives) that you have known for at least one year. List at least one previous supervisor. We will not contact references without prior coordination with applicants.

1. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Years acquainted*

Relationship*

2. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Years acquainted*

Relationship*

3. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Years acquainted*

Relationship*

AUTHORIZATION

I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment or for termination, if employed.

I authorize Provision to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, credit history, driving record, and other relevant information, if job-related. I give my full consent for all contacted individuals, including former employers, to provide information concerning this application.

I understand that if hired, employment is at-will, and may be terminated by myself or Provision at any time, with or without cause or notice, for any reason or no reason.

By entering your name, you agree to accept the terms of the above document with an electronic signature.*

I agreeI do not agree

You must agree to accept the terms of the document in order to submit an application.

Type signature*

Date*

Date

Upload a cover letter (optional)

Application for Employment