Employment Application

Equal Opportunity Employer

We consider applicants for all positions on the basis of qualifications and without regard to race, color, religion, sex, national origin, age, marital status, veteran status, disability, sexual orientation, expunged juvenile records, or pregnancy. False statements of omission of material facts will result in rejection of your application or removal from employment after hire.

Resumes will not be accepted in lieu of completed application

Please PRINT and complete this application in its entirety.

Position(s) Applied For / Date of Application
How did you learn about the company? (circle one)
Advertisement Friend Walk-in Recruiting Firm Current Employee Other: ______
Last Name First Name Middle Name
Street Address City State Zip Code
Telephone Number(s) where we can contact you: E-Mail Address
Home: ( ) Cell/Work: ( ) ______@______
Are you available to work (Circle) : Regular Full-time Regular Part-time, Hours: _____ Temporary-Hours: ____
Salary Requirements: ______
If you are under 18 years of age, can you provide required proof of you eligibility to work? / Yes No
Have you ever submitted an application with the company before? / Yes No
If yes, please give date: ______
Have you ever been employed with the company before? / Yes No
If yes, please give date: ______
Are you currently employed? / Yes No
May we contact your present employer for references? / Yes No
Have you ever been convicted of a crime or violation other than a minor traffic infraction? A conviction record will not necessarily bar you from employment. Factors such as job relatedness, age, time, seriousness, and nature of the offense will be taken into account. / Yes No
If yes, please explain: ______
Are you legally qualified to work in the United States?
(Proof of citizenship or immigration status will be required upon employment.) / Yes No
On what date would you be available for work? ______
Education And Training
Elementary School / High School / TechnicalSchool / College / Other
School Name and Location
Years Completed / 4 5 6 7 8 / 9 10 11 12 / 1 2 / 1 2 3 4 / 1 2 3 4
Diploma Degree / Yes No / Yes No / Yes No
Major Course(s) of Study
Employment Experience
Start with your present or most recent position. If information is already on your resume, fill in only those items not listed on your resume (i.e. reason for leaving, salary, etc.).
1. Employer / Dates Employed /
Work Performed
Address / From / To
Telephone Number(s) / Base Pay
Job Title
Supervisor / Start / Final
Reason for Leaving Can we Contact: YES NO
2. Employer / Dates Employed /
Work Performed
Address / From / To
Telephone Number(s) / Base Pay
Job Title
Supervisor / Start / Final
Reason for Leaving Can we Contact: YES NO
3. Employer / Dates Employed /
Work Performed
Address / From / To
Telephone Number(s) / Base Pay
Job Title
Supervisor / Start / Final
Reason for Leaving Can we Contact: YES NO
4. Employer / Dates Employed /
Work Performed
Address / From / To
Telephone Number(s) / Base Pay
Job Title
Supervisor / Start / Final
Reason for Leaving Can we Contact: YES NO
If you need additional space, please continue on a separate sheet of paper.
Special Skills and Qualifications
Summarize special job-related skills, licenses or degrees earned, and qualifications acquired from employment or other experience.
______
______
______
______
Have you ever had any job-related training in the United States military? / Yes No
If yes, please give dates: ______
Are you able to perform the essential requirements of the job? / Yes No
If no, what reasonable accommodations can be made to allow you to perform the essential functions of the job?
______
______
______
______
State any additional information you feel may be helpful to us in considering your application.
______
______
______
______
Emergency Information
In Emergency, Notify / City / State / Zip / Day Phone / Night Phone
Equal Employment Opportunity: We are an Equal Opportunity/Affirmative Action Employer. We are dedicated to a policy of non-discrimination in employment on the basis of race, color, religion, sex, national origin, age, sexual orientation, or mental and/or physical disability.
Application Process: Submit a completed application to nFUZION IT, 300 Missouri Ave, Suite 300, Jeffersonville, IN 47130 or
fax to (812) 285.8285.
Introductory Period: Newly hired and newly promoted employees serve in an introductory period of fixed duration as the final step in the selection process to demonstrate their ability to perform the work.
Compensation and Benefits: nFUZION IT offers competitive salaries and comprehensive benefits programs provided to all eligible employees; paid vacation, holidays and sick leave, medical insurance, life insurance, long-term disability and voluntary optional insurances. These plans are subject to change at the discretion of the company.
Immigration Law: In accordance with the Immigration Reform and Control Act of 1986 (IRCA) , all newly hired employees will be required to complete and sign an Employment Eligibility Verification Form (I-9) and present documentation verifying identity and employment eligibility.
This application for employment is good for one year. Consideration for employment after one year requires a new application.
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize nFUZION IT to investigate all of the statements contained in this application for employment as required in making an employment decision. I further authorize nFUZION IT to conduct background checks in relation to my employment history, driving, and/or criminal records.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written documentation or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in termination. I understand, also, that I am required to abide by all rules and regulations of the Employer.
______
Signature of Applicant Date

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