Employment Opportunities

Email Address

Last Name

First Name

Middle Initial

Street Address

City

State

Zip Code

Home Phone #

Cell Phone #

Are you 18 years or older? Are you 18 years or older? Yes No

Position Desired

Date you can start:

Are you employed now? Are you employed now? Yes No

If so, may we inquire of your present employer? If so, may we inquire of your present employer? Yes No

Please list your high school, college, and/or trade/business schools, their location, years attended, whether you graduated, and what you studied.

Please list any special skills, whether you served in the U.S. Military, your rank, and/or present membership in the National Guard or Reserves.

Please list your 3 most recent former employers, beginning with most recent, as well as your employment dates, position, and reason for leaving.

Salary/hourly wage desired for this position:

Please list your professional references (a minimum of 3 as supervisors), the employer, their title and contact information

May we contact all of the above supervisors? May we contact all of the above supervisors? Yes No

Which supervisor would you prefer we not contact?

When may we contact them?

Have you ever been convicted of a crime? Have you ever been convicted of a crime? Yes No

If yes, please explain:

Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Yes No

Do you have a valid driver's license? Do you have a valid driver's license? Yes No

What interests you about this position?

What do you feel you will contribute to this organization?

What motivates you to achieve your best?

What factors do you look for in an employer?

What career goals have you set for yourself?

What is your attitude/philosophy towards work?

Why should you be hired for this position?

Using a scale from 1-5, 1 being the lowest, 5 being excellent, how would you rate yourself on the following, starting with selling skills: Using a scale from 1-5, 1 being the lowest, 5 being excellent, how would you rate yourself on the following, starting with selling skills: 1 2 3 4 5

Tenacity Tenacity 1 2 3 4 5

Telephone/Customer Skills Telephone/Customer Skills 1 2 3 4 5

Motivation Motivation 1 2 3 4 5

Multi-Task Skills Multi-Task Skills 1 2 3 4 5

Ability to Prioritize Ability to Prioritize 1 2 3 4 5

Microsoft Windows Knowledge (as a user) Microsoft Windows Knowledge (as a user) 1 2 3 4 5

Microsoft Office Knowledge (Word, Excel etc.) Microsoft Office Knowledge (Word, Excel etc.) 1 2 3 4 5

Computer Skills/Use of Keyboard Computer Skills/Use of Keyboard 1 2 3 4 5

Do you have a conflict of interest as outlined above? Do you have a conflict of interest as outlined above? Yes No

If yes, describe the situation.

By entering your initials in this text box and submitting your application, you are signing that you have been informed of, read, understand and agree with our ADRP and Agreement to Arbitrate Policy, and agree to release the information submitted and that it is accurate to the best of your knowledge.