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Matchmaker          

PERSONAL DATA

* Last Name
* First Name
Middle Name
* Address Number & Street
* City
* State
* Zipcode
* Daytime Phone
* Evening Phone
* E-Mail:
Position Applied for:
Are you:
18 or older?
a previous employee?
currently employed?
legally eligible for employment in the United States of America?
a licensed driver? License no. State of Issue
How did you learn about the position?  
Check type of employment desired:
Can you travel if the job requires?
Will you relocate if the job requires?
Have you been convicted of a felony or misdemeanor?
(Conviction will not necessarily disqualify an applicant from employment)
IF Yes, please explain

EMPLOYMENT RECORD (List most recent employer first)

Employer 1
From:
To:
Address
Title
Beginning Salary
Ending Salary
Responsibilities
Reason for leaving
[ more ]

Employer 2
From:
To:
Address
Title
Beginning Salary
Ending Salary
Responsibilities
Reason for leaving
[ more ]   [ hide ]

Employer 3
From:
To:
Address
Title
Beginning Salary
Ending Salary
Responsibilities
Reason for leaving
[ more ]   [ hide ]

Employer 4
From:
To:
Address
Title
Beginning Salary
Ending Salary
Responsibilities
Reason for leaving
[ more ]   [ hide ]

Employer 5
From:
To:
Address
Title
Beginning Salary
Ending Salary
Responsibilities
Reason for leaving
[ hide ]

EDUCATION

Check the highest year completed:
Type of Degree 1
Major
Minor
Name and Location
Dates Attended: from
to
Graduated
Please list any scholastic honors, awards, subjects or special study, research, publications, patents and/or thesis:
[ more ]

Type of Degree 2
Major
Minor
Name and Location
Dates Attended: from
to
Graduated
Please list any scholastic honors, awards, subjects or special study, research, publications, patents and/or thesis:
[ more ]   [ hide ]

Type of Degree 3
Major
Minor
Name and Location
Dates Attended: from
to
Graduated
Please list any scholastic honors, awards, subjects or special study, research, publications, patents and/or thesis:
[ hide ]

ADDITIONAL SKILLS

Do you have personal computer skills?
If Yes, please describe the type of software and hardware that you are proficient in:
Please describe any other specialized training, apprenticeships and/or skills that you possess:

PROFESSIONAL ASSOCIATIONS

Please list any professional, trade, business or civic activities and offices held. You may exclude membership which would reveal race, color, religion, sex, gender, national origin, age, disability, marital, veteran status or any other legally protected status.

ADDITIONAL INFORMATION


Attach Resume:


Additional Comments:

NOTE TO APPLICANT

I feel that I can perform the job functions of the open position.

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

 

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information.

 

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

 

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

 

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute and agreement or contract for employment for any specified period or definite duration. U understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employee's president.

 

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete and I-9 Form in this regard.

 

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

 

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

 

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.


Applicants Signature
Date

EECO - VOLUNTARY PRE EMPLOYMENT INFORMATION FORM

Race / Ethnicity:
Gender:
McCoy Workplace Solutions is subject to certain governmental record keeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite applicants to voluntarily self-identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of the applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

   


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