"Employment Application Package"
Employment Application Package (Submitted applications remain on file for 90 days) Please ensure the following forms included in this package are filled out completely. 1. EMPLOYMENT APPLICATION 2. EEOC INFORMATION 3. SKILLS SELF ASSESSMENT 4. BACKGROUND CHECK APPLICATION Please attach a copy of your current resume to the Employment Application Package You may email your completed application to: email@example.com Or fax the complete package to: +1 877 852 7539 Employment Applicantion Full Name: Date: Last First M.I. Address: Street Address Apartment/Unit # City State ZIP Code Phone: ( ) E-mail Address: Date Available: Social Security No.: Desired Salary: $ Position Applied for: YES NO YES NO Are you a citizen of the United States? If no, are you authorized to work in the U.S.? YES NO Have you ever worked for this company? If yes, when? YES NO Have you ever been convicted of a felony? If yes, explain: Education High School: Address: YES NO From: To: Did you graduate? Degree: College: Address: YES NO From: To: Did you graduate? Degree: Other: Address: YES NO From: To: Did you graduate? Degree: References Please list three professional references. Full Name: Relationship: Company: Phone: ( ) Address: Full Name: Relationship: Company: Phone: ( ) Address: Full Name: Relationship: Company: Phone: ( ) Address: Previous Employment Company: Phone: ( ) Address: Supervisor: Job Title: Starting Salary: $ Ending Salary: $ Responsibilities: From: To: Reason for Leaving: YES NO May we contact your previous supervisor for a reference? Company: Phone: ( ) Address: Supervisor: Job Title: Starting Salary: $ Ending Salary: $ Responsibilities: From: To: Reason for Leaving: YES NO May we contact your previous supervisor for a reference? Company: Phone: ( ) Address: Supervisor: Job Title: Starting Salary: $ Ending Salary: $ Responsibilities: From: To: Reason for Leaving: YES NO May we contact your previous supervisor for a reference? Military Service Branch: From: To: Rank at Discharge: Type of Discharge: If other than honorable, explain: Disclaimer and Signature I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Signature: Date: Computer/People-Management Skills Assessment Use this form to document your skills inventory. It is helpful for you to keep a skills inventory and update it as you increase your skills. Then you will have this information readily available when you need to update your resume, respond to inquiries at interviews, and give an accurate picture of your skill level at salary reviews. You can also use it to start a skills development plan. Modify this form to create your own custom skill inventory. It presents several ways that you can list and measure your skills. Not all of the skills listed in the inventory will apply to you. In addition, you will want to add your particular skills. Desktop Computer Skills Skills for using a computer to produce business reports, presentations, letters, memos, and other office communications. General Skills Evaluate your skill level to identify areas you can work on. Power User Highly Skilled Adequate Marginal File Management Internet Microsoft Windows Windows Server 2003 Windows Server 2008 Web Hosting Web Design Network Engineering/Design Applications List specific software applications that you know how to use: Database Word Processing Spreadsheets Presentations Graphics Web Design Programming Languages People Management Skills Rate your skill level in working with people on the job in order to help them achieve goals. Exceptional Exceeds Meets Marginal Needs Work Requirements Requirements Active listening — Giving full attention to others without interrupting. Negotiation — Finding common ground between opposing parties. Conflict resolution — Bringing people together and reconciling differences. Service orientation — Actively looking for ways to help others. Persuasion — Persuading others to change their minds or behavior. Delegating — Matching tasks to people with the appropriate skills and interest to do them. Coordination — Adjusting actions in relation to the actions of others as necessary. Instructing — Teaching others to do something, making sure that they comprehend. Speaking — Talking to others to convey information effectively. Writing — Communicating effectively in writing as appropriate for the intended recipients. Monitoring — Assessing performance and stepping in to make improvements. Email etiquette — Taking time to write clearly and respond appropriately. Equal Employment Opportunity Form Applicant Information Full Name: Last First M.I. Address: Street Address Apartment/Unit # City State ZIP Code Home Phone: ( ) Social Security Number: Position Applied for: Voluntary Information This information is being requested in accordance with federal regulations. The information is voluntary and will not be used when considering you for employment with our company. Racial or Ethnic Group American Indian/Alaskan Asian/Pacific Islander Black/African American Hispanic/Latino White/Caucasian Other Gender Female Male Military Service Pre-Vietnam Era Vietnam Era Post-Vietnam Era Disabled Veteran How did you hear about this position? Newspaper Company Employee Professional Publication Job Fair Placement Office Web Site Other CONSENT TO PERFORM CRIMINAL HISTORY BACKGROUND CHECK IN COMPLIANCE WITH THE FCRA (FAIR CREDIT REPORTING ACT) Date Driver Lic.# (if checking driving record) Driver Lic. State Last Name First Name Middle Name Maiden and/or Other Last Names Used Address* City* State* Circle One**: Date of Birth** Social Security Number** Male / Female This authorization and consent for release of personal information acknowledges that DOXA, LLC. (Hereafter referred to as "Company") and/or its agent,, may now, or at any time I am assigned to, volunteer with or am employed by this Company, conduct investigations whether the records are of a public, private or confidential nature. These investigations might include, but are not limited to, searches of educational institutions attended; state driving records; financial or credit institutions, including records of loans; records of commercial or retail credit agencies; other financial statements; records of previous employment, including work history, efficiency ratings, complaints and grievances filed by or against me; records and recollections of attorney- at-law or of other counsel, whether representing me or any other person (in either a civil or criminal case in which I have been involved); records from the U.S. Veterans' Administration; criminal history information of file in local, state or federal agencies; and motor vehicle records, and following an employment offer, workers' compensation reports from either the Department of Labor, National Personnel Records or the Industrial Commission or similar agencies under the provisions of the Fair Credit Reporting Act 15, USC section 1681 et seq. I also authorize the National Personnel Records Center, or other custodian of my military service record, to release to DOXA, LLC, the following information and/or copies of documents from my military service record: DD214, service record, and any disciplinary records. I understand that these searches will be used to determine work assignment or employment eligibility under the company's employment or volunteer policies. Therefore, I authorize and consent for full release of records (either orally or in writing) to the authorized representatives of the company. In addition, I release and discharge the company and its agent and associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs expenses or any other charge or complaint filed with any agency arising from retrieving and reporting this information. I understand that according to the Federal Fair Credit Reporting Act, I am entitled to know whether employment was denied based upon the information obtained and to receive, upon written request, a disclosure of the background report. After reading this document, I fully understand its contents and authorize the background verification. * AS SHOWN ON THE ORIGINAL APPLICATION ** TO BE USED ONLY FOR CRIMINAL HISTORY SEARCHES, AND NOT A PART OF THE PERSONNEL FILE. I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS AUTHORIZATION IS TRUE, CORRECT AND COMPLETE. I UNDERSTAND THAT IF ANY INFORMATION PROVES TO BE INCORRECT OR INCOMPLETE THAT GROUNDS FOR THE CANCELING OF ANY AND ALL OFFERS OF EMPLOYMENT WILL EXIST AND MAY BE USED AT THE DISCRETION OF DOXA, LLC Signed this _________________ day of _________________________________, 20_______ Applicant (Print Name) _____________________________________________________________________ Applicant Signature ________________________________________________________________________