Application for Employment – Integrity IT Solutions

Name *

First

Last

Date *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Are you 18 years or older? *

Yes
No

Are you either a U.S. citizen or an alien authorized to work in the U.S.? *

Yes
No

Have you ever worked or attended school under another name? If so, under what name?

POSITION DESIRED

Position *

Start Date Available *

Wage rate desired: $ *

Hourly
Monthtly
Annually

Do you prefer: *

Full-time
Part-time

If part-time, hours per week desired:

Hours available to work: *

Days of week you are available to work: *

Are you able to work: *

Weekends
Holidays
Nights
Overtime

Have you previously worked for Integrity? *

Yes
No

Dates of employment with Integrity:

Reason(s) for leaving:

Former supervisor(s) at this company:

How did you learn about this opening? *

EDUCATION

High School: *

Graduated? *

Yes
No

Course of Study: *

Technical School: *

Graduated? *

Yes
No

Course of Study: *

College/University: *

Graduated? *

Yes
No

Course of Study: *

Post-Graduate Education: *

Graduated? *

Yes
No

Course of Study: *

Other education, training or special skills:

SKILLS

Are you experienced in using personal computers? *

Yes
No

Checkboxes

PC
Mac

Are you able to use Visio or other CAD programs? *

Yes
No

What other programs are you capable of using?

WORK EXPERIENCE

1.

Employer: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

From: *

To: *

Position Held: *

Reason for leaving: *

Supervisor's Name & Title: *

May we contact? *

Yes
No

Description of Duties: *

Starting Compensation: *

Final Compensation: *

2.

Employer: *

Address: *

From: *

To: *

Position Held: *

Reason for leaving: *

Supervisor's Name & Title: *

May we contact? *

Yes
No

Description of Duties: *

Starting Compensation: *

Final Compensation: *

3.

Employer:

Address:

From:

To:

Position Held:

Reason for leaving:

Supervisor's Name & Title:

May we contact?

Yes
No

Description of Duties:

Starting Compensation:

Final Compensation:

REFERENCES

Reference 1

Name: *

First

Last

Phone Number: *

Email: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Position or Title: *

Years Known: *

Reference 2

Name: *

First

Last

Phone Number: *

Email: *

Address: *

City, State, ZIP: *

Position or Title: *

Years Known: *

Reference 3

Name: *

First

Last

Phone Number: *

Email: *

Address: *

City, State, ZIP: *

Position or Title: *

Years Known: *

AUTHORIZATION AND ACKNOWLEDGMENTS

I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.

Candidate's Signature *

Date: *

RESUME

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