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Intro

Our company (“Company”) fully subscribes to the principles of Equal Employment Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, genetic information, disability, or any other basis prohibited by federal, state or local law. In accordance with requirements of the Americans with Disabilities Act and applicable federal, state and/or local laws, it is our policy to provide reasonable accommodation upon request during the application process to applicants in order that they may be given a full and fair opportunity to be considered for employment. As an Equal Opportunity Employer, we intend to comply fully with applicable federal, state and/or local employment laws and the information requested on this application will only be used for purposes consistent with those laws. To the extent required by applicable law, The Company maintains a smoke- free workplace.

Applicants for positions in Rhode Island please note that the Company is subject to Chapters 29-38 of Title 28 of the General Laws of Rhode Island and are therefore covered by the state's workers compensation law.

Department Applied for

Date

Personal Data

First Name

Last Name

Primary Phone

Alternative Phone

Address

Street

City

State

Zipcode

Salary Expectations

Education

Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:

Name, City and State Graduated Credits Major Minor GPA

High School

College/ University

Technical/ GED

Licenses/ Certification/ Other

Availability Questions

Are there any days, shifts or hours you will not work?

If yes, please explain

Will you work overtime, if required?

*Note: It is not necessary for you to identify unavailability for work because of religious observance or practice or any other protected classification. Subsequent to any job offer, we will consider whether a reasonable accommodation can be made.

When will you be able to start work?

How did you learn of the Company?

Have you ever applied or worked for the Company before?

If yes, provide last date

Are you legally authorized to work in the United States?

Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.

Professional References

Please list three individuals unrelated to you with whom you have worked who know your qualifications for this position:

Name Address Phone Relationship

Background Check

Are you willing to undergo a background check, in accordance with local law and regulations?

If yes, please explain

Have you ever been convicted of a felony?

If yes, please explain

Do you qualify for a Florida telephone salesperson license? (Is it possible to add a link to the application?)

If yes, please explain