Get documents about "Next Star Communications, Inc
Document Sample
5.15 Forms
(10/01/2012)
NEXT STAR COMMUNICATIONS, INC
APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
This application is current for only sixty (60) days. Thereafter it will be necessary for you to complete a new application.
PERSONAL INFORMATION DATE______________________________
NAME________________________________________________________________________________________________________________________
Last First Middle/Maiden
PRESENT ADDRESS_________________________________________________________________________________________________
Street City State Zip
PREVIOUS ADDRESS___________________________________________________________________________________________________________
Street City State Zip
TELEPHONE (_______)________________________ EMAIL ADDRESS _______________________________________________________________
SOCIAL SECURITY NO __________/________/__________ ARE YOU 17 OR OLDER? YES _____ NO _____
ARE YOU A CITIZEN OF THE U.S.? YES _____ NO _____ TYPE OF VISA _______________ NO _____________________
NOTIFY IN AN EMERGENCY _____________________________________________________________________________________________________
Name Relationship
_______________________________________________(______)________________________(______)________________________________________
Address Work Phone Home Phone
Position(s) Applied for ________________________________________ Date Available_________________________
Type of Employment: Full time ________ Part time ________ Temporary ________
What days are you able to work?
Mon __________ Tue __________ Wed __________ Thurs __________ Fri __________ Sat __________
Wage requirement ____________________Hourly/Annually
WORK EXPERIENCE - Please identify the fields in which you have had experience or training
[ ] Retail Sales [ ] Customer Service [ ] Security/Loss Prevention [ ] Spreadsheet
[ ] Cash Register [ ] Maintenance [ ] Mechanical Training [ ] Typing
[ ] Data Entry [ ] Stock/Inventory [ ] Electrical Training [ ] General Clerical
[ ] Management [ ] Calculator [ ] Power Equipment [ ] Word Processing
How did you hear about Next Star Communications? __________________________________________________________________________
Have you ever applied for a job with us before? Yes _______ No _______ Have you ever worked for us before? Yes _______ No _______
Do you have any relatives employed by Next Star Communications? Yes _______ No _______
If Yes, what relationship? ____________________ what location? ____________________
Are you Bilingual? Yes_________ No___________ If yes, what language? _____________________________
Have you ever been convicted of a felony or misdemeanor; including DUI, etc? (A conviction may not necessarily disqualify an applicant) Note: An
applicant with a court-ordered sealed record may answer “No” with respect to that conviction. ( ) No ( ) Yes
If yes, state, date, court, and place where offense occurred:
_________________________________________________________________________________________________________________
Have you ever been discharged from a position or resigned to avoid discharge? ( ) No ( ) Yes
If yes, describe circumstances _________________________________________________________________________________________
5.15 Forms
(10/01/2012)
EDUCATION
Name and Location Graduated Course of Study
__________________________________________ Yes ( ) No ( ) _______________________________
__________________________________________ Yes ( ) No ( ) _______________________________
__________________________________________ Yes ( ) No ( ) _______________________________
Are you currently enrolled in a course of study?
If yes, what? _______________________________________ where? __________________________________________________
EMPLOYMENT HISTORY
Start with the most recent or present employer, fill in an explanation of any lapse in employment
______________________________________________________________ ____________________________________________
Employer and Address Telephone No
______________________________________________________________ ____________________________________________
Job Title and Duties Date Hired Starting Rate
______________________________________________________________ ____________________________________________
Reason for Leaving Date Left Ending Rate
_____________________________________________________________________________________________________________________________________________
Immediate Supervisor (Name and Position)
May we contact this employer prior to extending conditional offer of employment? Yes ( ) No ( )
Explain any Lapse in Employment ___________________________________________________________________________________
______________________________________________________________ ____________________________________________
Employer and Address Telephone No
______________________________________________________________ ____________________________________________
Job Title and Duties Date Hired Starting Rate
______________________________________________________________ ____________________________________________
Reason for Leaving Date Left Ending Rate
_____________________________________________________________________________________________________________________________________________
Immediate Supervisor (Name and Position)
May we contact this employer prior to extending conditional offer of employment? Yes ( ) No ( )
Explain any Lapse in Employment ___________________________________________________________________________________
______________________________________________________________ ____________________________________________
Employer and Address Telephone No
______________________________________________________________ ____________________________________________
Job Title and Duties Date Hired Starting Rate
______________________________________________________________ ____________________________________________
Reason for Leaving Date Left Ending Rate
_____________________________________________________________________________________________________________________________________________
Immediate Supervisor (Name and Position)
May we contact this employer prior to extending conditional offer of employment? Yes ( ) No ( )
5.15 Forms
(10/01/2012)
It is the intention of Next Star Communications to staff our organization with honest people of integrity. Therefore, we ask you to read and understand the statement below before signing and dating
your application.
The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind will be sufficient cause for my
application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.
I authorize the employer to contact and obtain information about me from previous employers, educational institutions and “references” I provided, and any other party necessary to verify the
accuracy of information I disclosed in this application, a related employment resume or a personal interview. To assist in the processing of my Application, I waive all rights and claims I may
otherwise have against the employer or its representatives for seeking and using information to evaluate my employment request and all other persons, corporations and organizations who
provide information for this purpose.
The Fair Credit Reporting Act requires us to advise you that a routine investigation consumer report may be conducted relative to your character, general reputation, personal characteristics,
and credit history. Upon written request, we will provide you with additional information concerning the source, nature, and scope of any such report requested by us.
This application will expire in 60 days. After that date, unless otherwise notified, I understand that my status as an application will end. I may re-apply for employment in the future by completing
a new application.
This application is not an employment agreement. If I accept an offer of employment I understand I may resign at any time, and the employer may terminate my employment at any time, with or
without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement
with terms contrary to the foregoing and then only in writing signed by such officer.
I understand that if hired, I will be put on a 90 day probation period. If I fail to meet Next Star Communications expectations within the 90 day probation period termination is likely to occur.
I understand that if hired, I will be required to offer for examination documents proving that I am a United States citizen or an alien currently authorized to work in the United States. I also
understand that my continued employment is contingent upon my providing the necessary documentation within the prescribed time frame.
Business needs may at times make the following conditions mandatory: overtime, shift work, a rotating work schedule, or a work schedule other than that for which I was originally hired. I
understand and accept these conditions of continuing employment.
We endorse a DRUG – FREE ENVIRONMENT and we reserve the right to drug screen all applicants and, if hired, to randomly perform drug testing.
I authorize the employer to receive any Georgia criminal history record information pertaining to me which may be in the files of any state or local criminal justice agency in Georgia.
Signature Date
