Application for Employment - Indianapolis, Lawrence, Greenwood

Position(s) applied for or type of work desired*

Applicant name*

Date

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address

Phone

Type of employment desired

Full Time
Part Time
Temporary

Date you will be available to start work*

Are you able to meet the attendance requirements?

Yes
No

Do you have any objection to working overtime if necessary?

Yes
No

Can you travel if required by this position?

Yes
No

Have you ever been previously employed by our organization?

Yes
No

Can you submit proof of legal employment authorization and identity?

Yes
No

If you are under 18, can you furnish a work permit if it is required?

Yes
No

Have you ever been convicted of a crime in the last 7 years?

Yes
No

Have you ever been convicted of a crime?

Yes
No

If yes, please explain (a conviction will not automatically bar employment):

How were you referred to us?

Employment History

Please provide all employment information for your past four employers starting with the most recent

Employer

Position held

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone #

Immediate supervisor and title

Dates employed: from

Dates employed to:

Salary

Job summary

Reason for leaving

Employer

Position held

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone #

Immediate supervisor and title

Dates employed: from

Dates employed to:

Salary

Job summary

Reason for leaving

Employer

Position held

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone #

Immediate supervisor and title

Dates employed: from

Dates employed to:

Salary

Job summary

Reason for leaving

Other Skills and Qualifications

Summarize any job-related training, skills, licenses, certificates, and/or other qualifications

Educational History

List school name and location, years completed, course of study, and any degrees earned

References

List 3 references names, telephone numbers, and years known (do not include relatives or employers)

Pre-employment Inquiry Release

In association with my application for employment with Metric, or contracting agencies, I authorize investigative background inquiries on myself that may include consumer, criminal, driving and other reports. These reports will include information as to my character, work habits, performance and experience along with reasons for leaving previous employers. This form must be completed, in full, to be considered for employment.

Additionally, I understand that requests for information will be made from various federal, state, and other agencies which maintain records relating to past activities including my driving, credit, criminal, civil and other experiences. A copy of this form is of the same force and effect as the original.

I authorize, without reservation, any party and agency contacted by this organization to furnish the above mentioned information. Furthermore, I hereby waive my right to bring any cause of actions against these individuals for defamation, invasions of privacy or any other reason because of their statements. And also release Metric or contracting agencies from any and all claims based on any actions taken based on the information obtained.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Social Security Number

Driver’s License Number

License State

Date of Birth

Applicant signature

Date

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Name

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