AGreatPlaceToWork

ApplicationForEmployment

Weconsiderapplicantsforallpositionswithoutregardtorace,color,religion,sex(gender),nationalorigin,age,disability,sexualorientation,maritalorveteranstatus,oranyotherlegallyprotectedstatus.

Position(s) AppliedFor / DateofApplication
HowDidYouLearnAboutUs?
AdvertisementEmploymentAgency / FriendRelative / Walk-InOther

PersonalInformation(Completeallapplicableinformation-pleaseprint)

Name(Full-Last,First,MI) / SocialSecurityNumber
StreetAddress / City / State / Zip
HomePhone / BusinessPhone / Canyoutravelifajobrequiresit?
Areyouwillingtowork:FullTimePartTime
TemporaryWeekendsEveningsNights / Whencouldyoustartemployment?
Haveyoueverappliedforemploymentwithourcompany?
YesNoWhen? / Haveyoupreviouslybeenemployedbyourcompany?
YesNoWhen?
AreyoulegallyauthorizedtoworkintheUnitedStates?
YesNo / Ifyouareundereighteen(18)yearsofage,canyouproviderequiredproofofyoureligibilitytowork?YesNo
Haveyoubeenconvictedofafelonywithinthelastseven(7)years?YesNo
(Convictionwillnotnecessarilydisqualifyanapplicantfromemployment)
Ifyes,pleaseexplain

EmploymentHistory(Listbelowlastfouremployers,startingwiththemostrecentonefirst)

1) PresentorLastPosition / NameofCompany / FromMo/Yr / ToMo/Yr
StreetAddress / City / State / Zip
Duties / ReasonforLeaving
StartingHourlyRate / FinalAnnualSalary / Bonus / Commission / MaywecontactyourSupervisor?
NameofSupervisor / TitleandDepartmentofSupervisor / PhoneNumberofSupervisor
2) PresentorLastPosition / NameofCompany / FromMo/Yr / ToMo/Yr
StreetAddress / City / State / Zip
Duties / ReasonforLeaving
StartingHourlyRate / FinalAnnualSalary / Bonus / Commission / MaywecontactyourSupervisor?
NameofSupervisor / TitleandDepartmentofSupervisor / PhoneNumberofSupervisor
3) PresentorLastPosition / NameofCompany / FromMo/Yr / ToMo/Yr
StreetAddress / City / State / Zip
Duties / ReasonforLeaving
StartingHourlyRate / FinalAnnualSalary / Bonus / Commission / MaywecontactyourSupervisor?
NameofSupervisor / TitleandDepartmentofSupervisor / PhoneNumberofSupervisor
4) PresentorLastPosition / NameofCompany / FromMo/Yr / ToMo/Yr
StreetAddress / City / State / Zip
Duties / ReasonforLeaving
StartingHourlyRate / FinalAnnualSalary / Bonus / Commission / MaywecontactyourSupervisor?
NameofSupervisor / TitleandDepartmentofSupervisor / PhoneNumberofSupervisor

EducationInformation

HighSchoolorGED / DatesAttended
FromMo/Yr / ToMo/Yr / City / State / Degree / SubjectsStudied
College / DatesAttended
FromMo/Yr / ToMo/Yr / City / State / Degree / Major / GPA
College / DatesAttended
FromMo/Yr / ToMo/Yr / City / State / Degree / Major / GPA
GraduateSchool / DatesAttended
FromMo/Yr / ToMo/Yr / City / State / Degree / Major / GPA
Other / DatesAttended
FromMo/Yr / ToMo/Yr / City / State / Degree / Major / GPA

AdditionalInformation

Stateanyadditionalinformationyoufeelmaybehelpfultousinconsideringyourapplication.

References

1)
(Name) / (Address) / (Phone)
2)
(Name) / (Address) / (Phone)
3)
(Name) / (Address) / (Phone)

PleaseReadTheFollowingStatementCarefully

Inconsiderationofmyemployment,Iagreetoconformtothepoliciesandproceduresofthecompany. Iunderstandthatinaccepting
thisapplication,thecompanyisinnowayobligatedtoprovidemewithemploymentandthatIamnotobligatedtoacceptemploymentifoffered. Furthermore,ifemployed,IunderstandthatIamemployed"atwill"andthatmyemploymentandcompensationcanbeterminatedwithorwithoutcause,andwithorwithoutnoticeatanytime.
Thisapplicationforemploymentshallbeconsideredactiveforaperiodoftimenottoexceedforty-five(45)days. Anyapplicantwishing tobeconsideredforemploymentbeyondthistimeperiodshouldinquireastowhetherornotapplicationsarebeingacceptedatthattime.
CGI,IncparticipatesintheE-VerifyProgram;onlyindividualswiththelegalrighttoworkinthiscountryareeligibletobehired.
IdeclareunderpenaltyofperjuryunderthelawsofNevadathatthefactscontainedinthisapplicationaretrueandcompletetothebestofmyknowledge.Iunderstandthatanyfalsifedstatementsonthisapplicationoromissionoffactoneitherthisapplicationorduringthepre-employmentprocesswillresultinmyapplicationbeingrejected,or,ifIamhired,inmyemploymentbeingterminated.
Ialsounderstandthatanyofferofemploymentisconditionedonthecompletionofpre-employmenttestsanddocumentation. Iauthorizeinvestigationofallstatementscontainedintheapplication. Iwill,uponrequest,signallnecessaryconsentforms.
Date / Signature