The position I am applying for is:
How did you learn about this job opening? Please check all sources.
First Name
Middle Name
Last Name
Address
Street
City
State
Zip Code
Phone Number
Email Address
Please list an additional phone number where we can leave a message:
Name
Relationship
Phone Number
Please answer all questions completely and accurately.
Check all counties you are available to work in:
Which type of work you would accept (please mark all that apply)?
Shift preferred (please mark all that apply):
Are you legally eligible to be employed in the U.S.?
Are you 18 years of age or older?
(proof of identity and eligibility will be required upon employment)
Driving is a requirement of this position.
Do you have a valid driver’s license?
Do you have access to a reliable vehicle?
Do you have vehicle insurance?
Have you ever been convicted of a crime? (Other than a minor traffic ticket)
If YES, please indicate the nature of the offense, date , state and disposition. (A conviction record is not an automatic bar to employment and the nature, recency and disposition of the offense will be considered only as it relates to the job for which you are applying) - Criminal background checks and child dependent adult abuse checks are completed prior to offer of employment.
Explain
High School Diploma Or Equivalent
Describe any skills, specialized training, apprenticeship and applicable extra-curricular activities.
List equipment and computer software you can operate.
References
Name, address, and telephone number of three references who are not related to you.
Name
Address
Phone Number
Name
Address
Phone Number
Name
Address
Phone Number
Employment Experience
List your three most recent employers. Start with your present or last job.
1. Employer
Dates Employed From/To
Work performed
Address
Phone Number
Hourly Rate/Salary Starting/Final
Job Title
Reason for leaving
Supervisor
May we contact the employer listed above?
If no, why?
2. Employer
Dates Employed From/To
Work performed
Address
Phone Number
Hourly Rate/Salary Starting/Final
Job Title
Reason for leaving
Supervisor
May we contact the employer listed above?
If no, why?
3. Employer
Dates Employed From/To
Work performed
Address
Phone Number
Hourly Rate/Salary Starting/Final
Job Title
Reason for leaving
Supervisor
May we contact the employer listed above?
If no, why?
Applicant’s Statement
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. If I wish to be considered for employment beyond this time period, I understand that I need to inquire as to whether or not applications are being accepted at that time.
I hereby acknowledge that any employment relationship with Insight Partnership Group, LLC (IPG), is of an at-will nature, which means that IPG may discharge at any time with or without cause. I understand that neither this document nor any offer of employment from IPG constitutes an employment contract unless a specific document to that effect is executed by IPG and me in writing.
In the event of employment, I understand that false or misleading information given in my application or interview(s) shall be considered sufficient cause for dismissal. I further understand that an incomplete application or an absence of my signature on this application is just cause for rejection of this application. I understand that I am required to abide by all rules and regulations of the employer.
Signature of Applicant
Date of Application
It is the policy of Insight Partnership Group, LLC (IPG), to provide equal treatment to all IPG employees and applicants for IPG employment without regard to race, color, religion, political affiliation, creed, sex, sexual orientation, national origin or ancestry, age, mental or physical disability, marital status, except as bona fide occupational qualifications may require otherwise. This policy applies to all Human Resources actions and procedures including, but not limited to: recruitment, selections, training, compensation, benefit programs, promotion, demotion, transfer and termination of employment.
Individuals in need of special accommodations are asked to notify our office in advance.
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