Application for Remote/Virtual Employment

Remote/Virtual Employment Application
- Name:*
  
  First NameLast Name
- Address:*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Phone Number:*
  
  Area CodePhone Number
- E-mail Address:*
  
  Confirmation Email
- Date of Birth*
  
  MonthDayYear
  Date of Birth
- Social Security Number*
- YesNo
- Walk-InEmployeeNewspaper AdFacebookTwitterInstagramFamily/FriendPostcard MailingUnemploymentJob FairSocial Services AgencyCraigslistOther
- Position of Interest
- Full Time (W2)Full Time (1099)Part Time (W2)Part Time (1099)
- To ensure that we match you with the positions that meet your scheduling requirements please let us know the the number of hours you want to work, date you are available to start and hours that you are available for virtual staffing.
- 15 hours per week or less (Spare Time)15 - 25 hours per week (Part Time)25 - 40 hours per week (Full Time)40+ hours per week (Over Time)
- Date You Can Start:*
  
  MonthDayYear
  Date
- 6:00 am - 11:00 am12:00 pm - 5:00 pm6:00 pm - 11:00 pm12:00 am - 5:00 am
- 6:00 am - 11:00 am12:00 pm - 5:00 pm6:00 pm - 11:00 pm12:00 am - 5:00 am
- 6:00 am - 11:00 am12:00 pm - 5:00 pm6:00 pm - 11:00 pm12:00 am - 5:00 am
- 6:00 am - 11:00 am12:00 pm - 5:00 pm6:00 pm - 11:00 pm12:00 am - 5:00 am
- 6:00 am - 11:00 am12:00 pm - 5:00 pm6:00 pm - 11:00 pm12:00 am - 5:00 am
- 6:00 am - 11:00 am12:00 pm - 5:00 pm6:00 pm - 11:00 pm12:00 am - 5:00 am
- 6:00 am - 11:00 am12:00 pm - 5:00 pm6:00 pm - 11:00 pm12:00 am - 5:00 am
- High School/GED*
  Name of High School/GED Program Attended
- Number of years completed*
- YesNo
- College
  Name of College/University Attended
- Number of years attended
- YesNo
- Area of Study/Degree
- Graduate School
  Name of Graduate School Attended
- Number of years attended
- YesNo
- Area of Study/Degree
- Trade School/Other
- Number of years attended
- YesNo
- Area of Study/Degree
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- Describe your skills:*
- Training or Certifications:
- Current Employer:*
  Nsme of CURRENT Employer ot NONE if not Employed
- Position:
- Start Date
  
  MonthDayYear
  Date
- Reason for Leaving?:
- YesNo
- Previous Employer 1*
- Position:*
- Start Date*
  
  MonthDayYear
  Date
- End Date
  
  MonthDayYear
  Date
- Reason for Leaving
- Previous Employer 2
- Position
- Start Date
  
  MonthDayYear
  Date
- End Date
  
  MonthDayYear
  Date
- Reason for Leaving
- Please list two (2) references that are familiar with your work life.
- Professional Reference 1
- Name:*
  
  First NameLast Name
- Phone Number*
  
  Area CodePhone Number
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Email*
  example@example.com
- Years Known:*
- Professional Reference 2
- Name:*
  
  First NameLast Name
- Phone Number*
  
  Area CodePhone Number
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Email*
  example@example.com
- Years Known:*
- Upload Cover Letter:
  
  Upload a File
  
  Cancelof
- Upload Resume:
  
  Upload a File
  
  Cancelof
- By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
- Signature*
- Should be Empty:

Remote/Virtual Employment Application