Employment Application

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

GENERAL INFORMATION: Date Click here to enter a date.

Name                  Last First Middle Initial

Current address

                       

Number Street City State Zip

How long at current address? Email Address for Contact Purposes           

Telephone

(       )      

Are you under age 18? Yes No If “YES”, can you provide proof of your eligibility to work? Yes NoAre you currently authorized to work in the United States? Yes No Proof of eligibility will be required if hired

Position applied for      

Job Number      

Employment desired FULL-TIME PART-TIME FULL- OR PART-TIME

Location Desired

      Are you willing to relocate? Yes No

When are you available to start work?

     

Have you applied for employment with Cline Design before? Yes No

EDUCATION: Name of school Location Number of years

completed

Degree and Major

College/University                        

                       

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Cline Design Associates PA is an equal opportunity employer. As such, we provide employment opportunities without regard to race, color, religion, national origin, gender, age, disability, veteran status, military service, or

other characteristics provided by law.

College/University

High School                        

Other                        

REFERENCES: Please list two professional references. Co-workers and former supervisors preferred.

Name

      Name

     

Position

      Position

     

Company

      Company

     

Address

      Address

     

           Telephone

(       )       Telephone

(       )      

WORK EXPERIENCE:

Please list your work experience beginning with the most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer

      Name and title of last

supervisor

Employment dates

Salary

Address      City, State, Zip             From      

To      Start      Final      Phone number      

May we contact employer? Yes No Your last job title

     

Reason for leaving (be specific)

     

List the positions you held, duties performed, skills used or learned, advancements or promotions

     

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Name of employer       Name and title

of last supervisor

Employment dates

Salary

Address      City, State, Zip             From      

To      Start      Final      Phone number      

May we contact employer? Yes No Your last job title

     

Reason for leaving (be specific)

     

List the positions you held, duties performed, skills used or learned, advancements or promotions      

Name of employer       Name and title of last

supervisor

Employment dates

Salary

Address      City, State, Zip             From      

To      Start      Final      Phone number      

May we contact employer? Yes No Your last job title

     

Reason for leaving (be specific)

     

List the positions you held, duties performed, skills used or learned, advancements or promotions      

Name of employer       Name and title of last

supervisor

Employment dates

Salary

Address      City, State, Zip             From      

To      Start      Final      Phone number      

May we contact employer? Yes No Your last job title

     

Reason for leaving (be specific)

     

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List the positions you held, duties performed, skills used or learned, advancements or promotions      

Do you have a driver’s license? Yes NoExpiration date

     

Have you had any accidents during the past three years? No How many?

     

Have you had any moving violations during the past three years?

No How many?

     

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EMPLOYMENT APPLICATION WAIVER (Please review and sign the following. If you have any questions, please contact us)

In exchange for the consideration of my employment application by Cline Design Associates, (hereinafter called “the Company”), I agree that:Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, shall serve to create an actual or implied contract of employment, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, Both the undersigned and the Company may end the employment relationship at any time, without specified notice or reason. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, all previous employers (unless otherwise indicated), references and others and hereby release the Company from any liability as a result of such contact.I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, and personal characteristics. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.Signature of applicant Date

Submission of this application by email constitutes an electronic signature and authorization for the Company to investigate all statements contained in this application.

Thank you for completing the employment application and for your interest in our firm.

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INVITATION TO SELF-IDENTIFY

(To Be Filed Separately from Personnel File)

Federal law requires certain federal contractors and subcontractors to take affirmative action to employ and advance in employment minorities, females, Vietnam Era and other covered veterans, qualified individuals with disabilities, and disabled veterans. If you are a member of one of these groups and would like to be considered under the program, please tell us. You may inform us of your desire to benefit under the program at this time and/or any time in the future. Submission of this information is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or removal from consideration for employment. Any information submitted would be used only in ways that are not inconsistent with applicable law. Information submitted relating to disability will be kept confidential except that: (1) managers and supervisors may be informed regarding restrictions on work or duties and regarding necessary accommodations; (2) first-aid and safety personnel may be informed when and to the extent appropriate if the condition may require emergency treatment; and (3) government officials may be informed as may be required by law. If you have a disability and would like to be considered under our affirmative action plan, it would assist us if you would tell us: (1) any special methods, skills, and procedures that qualify you for the job that you might not otherwise be able to do because of your disability; and (2) the accommodations that we could make that would enable you to perform the job properly and safely, including equipment, job restructuring, or other accommodations.

NAME:      SEX: Female Male

Are you a Vietnam-era veteran? Yes No

Vietnam era means an eligible veteran any part of whose active military, naval, or air service was during the Vietnam Era.

Are you an “other covered” veteran? Yes No

“Other covered” veteran means other eligible veterans who while serving on active duty in the Armed Forces, participated in a United States military operation for which an Armed Forces medal was awarded and any Veteran during the 3-year period beginning on the date of such veteran’s discharge or release from active duty.

Are you a disabled veteran? Yes No

Disabled veteran means: (1) a veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the secretary; or (2) a person who was discharged or released from active duty because of a service connected disability.

Are you an individual with a disability? Yes No

If you answered yes identifying yourself as a disabled veteran and/or individual with a disability, please describe any accommodations that are necessary to enable you to perform the job properly and safely:

     

Race/Ethnicity:

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White (Not of Hispanic origin). All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.Black (Not of Hispanic origin). All persons having origins in any of the black racial groups of Africa.Hispanic. All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin regardless of race.Asian or Pacific Islander. All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa.American Indian or Alaskan Native. All persons having origins in any of the original peoples of North America and who maintain cultural identification through tribal affiliation or community recognition.

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