About

Applicant Full Name:
Home Address:
City/State/ZIP:
Number of years at this address:
Daytime phone ................................... Evening phone
Social Security Number:
Driver's License (State/Number):
Contact Name:
Relationship to you:
Address:
Daytime phone:____________________Evening phone:
Job Position Applied For:
Have you applied to our company previously?

Yes
No
If yes, when?
Are you at least 18 years old?
*

Yes
No
Do you have a reliable means of transportation to travel to and from work?
*
Yes
No
If you are offered employment, when would you be available to begin work?
What reasonable accommodation, if any, would you request?
If hired, are you able to submit proof that you are legally eligible for employment in the United States?
Yes
No
Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?
Yes
No
Have you ever plead “no contest”, nollo, or guilty to a crime, or been convicted of a crime? (Misdemeanor or Felony)
Yes
No
Are any charges currently pending against you?
Yes
No
13. Has any adjudication ever been withheld?
Yes
No
(Note: Answering “YES” to these questions does not constitute an automatic bar to employment.) If you answer “YES” to any of the proceeding questions 12 through 14, Please give dates and details:
14. Do you have any commitments to any other employer, which may affect your employment with us?
Yes
No
If yes, please explain
15. Have you ever been a defendant in a civil suit on an intentional tort (assault, battery, false imprisonment, invasion of privacy, intentional infliction of emotional distress, intentional wrongful death?
Yes
No
If yes, please explain:
(Note: Answering “YES” to these questions does not constitute an automatic bar to employment.) Only those crimes which are substantially related to the position you are seeking will be considered.
16. Applicant's Skills Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)
Ability or SkillYears of Experience Rating [ ]Microsoft Office Suite (Word, Excel, etc.)__________________ 1 2 3 4 5 [ ]Accounting/Bookkeeping___________________ 1 2 3 4 5 [ ]Customer service________________________ 1 2 3 4 5 ___________________________________________1 2 3 4 5
_________________________
_________________________
_________________________
17. Applicant Employment History List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.
1. Employer Name:
Supervisor Name:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):
2. Employer Name:
Supervisor Name:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):
3. Employer Name:
Supervisor Name
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):

CERTIFICATION I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize Ascend Business Solutions, LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Ascend Business Solutions, LLC, except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

EMPLOYMENT APPLICATION

Please complete the entire application.

Who should be contacted if you are involved in an emergency?

Emergency Contact

2 of 3 Applicant's Education and Training

References

List any two non-relatives who would be willing to provide a reference for you.

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