Job Application

Employment Form

Name*

First Last

Date*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Are you legally authorized to work in the U.S?*

Yes

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)*

Yes

During the last ten years, have you ever been convicted of a crime other than minor traffic offense?*

Yes

If yes, please provide details (dates and location for all convictions)

Have you ever been terminated from employment or asked to resign by an employer?*

Yes

If yes, please provide company names and details

Date you can start*

Hourly Rate/Salary desired*

Position desired*

Are you currently employed?*

Yes

If so may we inquire of your present employer?*

Yes

PLEASE CHECK SCHEDULE AVAILABILITY*

I am available and desire to work FULL-TIME and do not have restrictions on my hours and days. (Complete Section B.)

I am available and desire to work PART-TIME (please complete Sections A & B)

Section A

I am only available for PART-TIME because:*

Student

Other Job

Other (Explain)

Explain:

Section B

NOTE: WORK SCHEDULES ARE BASED UPON THE NEEDS OF THE BUSINESS AND MAY BE SUBJECT TO CHANGE ON A WEEKLY BASIS.

Can you work overtime, including weekends?*

Yes

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?*

Yes

How did you hear about us?*

Walk In

Referral

Other

Have you ever worked for this company before?*

Yes

Explain:

Do you know anyone who works for our company?

Yes

If yes, who?

EDUCATION	Name & Location of School	Years Attended	Degree Received	Subjects studied/Major
High School
College or University
Trade, Business or Correspondence School

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for?

Computer Skills (please describe):

EMPLOYMENT HISTORY:

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

From:	To:	Employer Name:	Telephone:
Job Title:		Address:
Immediate Supervisor:		Summarize the nature of work performed and job responsibilities:

From:	To:	Employer Name:	Telephone:
Job Title:		Address:
Immediate Supervisor:		Summarize the nature of work performed and job responsibilities:

From:	To:	Employer Name:	Telephone:
Job Title:		Address:
Immediate Supervisor:		Summarize the nature of work performed and job responsibilities:

From:	To:	Employer Name:	Telephone:
Job Title:		Address:
Immediate Supervisor:		Summarize the nature of work performed and job responsibilities:

From:	To:	Employer Name:	Telephone:
Job Title:		Address:
Immediate Supervisor:		Summarize the nature of work performed and job responsibilities:

From:	To:	Employer Name:	Telephone:
Job Title:		Address:
Immediate Supervisor:		Summarize the nature of work performed and job responsibilities:

From:	To:	Employer Name:	Telephone:
Job Title:		Address:
Immediate Supervisor:		Summarize the nature of work performed and job responsibilities:

References:

Give the names of three persons not related to you, whom you have known at least three (3) years.

Please read carefully before signing.

ACS Group is an equal opportunity employer. ACS Group does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service. I understand thet neither the completion of this application nor any other part of my consideration for employment establishes any obligation for ACS Group to hire me. If f am hired, I understand that either ACS Group 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 ACS Group has the authority to make any assurance to the contrary. I attest with my signature below that I have given to ACS Group true and complete information on this application. No requested information has been concealed. I authorize ACS Group 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. ACS Group participates with eVerify. We are committed to compliance with all regulation issued by the Department of Homeland Security.

Sign Date*

Signature*

Sign Here

Wabash