Schat Communications Employment Application

We do not discriminate on the bases of race, color, religion, national origin, gender, sexual orientation, age, or disability. It is our intention that all qualified applicants will be given equal opportunity and that selection decisions be based on job-related factors.Each question is to be answered fully and accurately. No action can be taken on this application until all questions have been answered. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Job Applied For*

Today's Date*

Are you seeking : Full-Time , Part-Time, or Temporary employment?*

Last Name*

First Name *

Middle Name

Current Street Address*

City *

State*

Zip Code*

Are you 18 years of age or older? (If you are hired you may be required to submit proof of age).*

*If hired, can you provide proof you are eligible to work in the U.S.? **

Have you ever applied here before? If yes, when?*

Were you previously employed here before? If yes, when?*

Have you ever been convicted of or pleaded guilty to any law violation (except speeding or parking violations)? If yes, give details. (A “Yes” answer does not automatically disqualify you from employment, because the nature of the offense, date, and the job for which you are applying will also be considered.)*

Are you now or do you expect to be engaged in any other business employment? If yes, please explain.*

Do you have a valid drivers license? *

Drivers License Number

Class of License

Have you had your driver's license suspended or revoked in the last 3 years? If yes, please explain.

List professional, trade, business, or civic activities and offices held. (Exclude any labor organizations and memberships which reveal race, color, religion, national origin, gender, age, disability, or other protected status).

History of Education

Highschool or GED*

Number of years completed*

Diploma, Degree, or Certificate*

College or University

Number of years completed.

Diploma, Degree, or Certificate.

Subjects studied.

Vocational or Technical

Number of years completed:

Diploma, Degree, or Certificate:

Subjects studied:

What skills or additional training do you have that are related to the job for which you are applying?*

What machines or equipment can you operate that are related to the job for which you are applying?

What personal traits or skills do you possess that you feel will make you a valuable team member? *

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If you are self-employed, provide the firm's name and supply business references.

Name of Employer*

Address*

Job titles and duties *

Name of Supervisor

Phone Number*

Date of Employment: (Start date - End date)*

Pay Rate Received

Reason for Leaving *

Name of Employer (2)*

Address(2)*

Job titles and duties (2)*

Name of Supervisor (2)

Phone Number(2)*

Date of Employment: (Start date - End date)(2)*

Pay Rate Received (2)

Reason for Leaving (2)*

Name of Employer (3)*

Address(3)*

Job titles and duties (3)*

Name of Supervisor (3)

Phone Number(3)*

Date of Employment: (Start date - End date)(3)*

Pay Rate Received (3)

Reason for Leaving (3)*

Provide three references, Not Relatives or former employers.

References

Phone Numbers

1.*

2.*

3.*

Reason for applying*

Please read carefully before signing:

I certify that all information provided in this employment application is trueand complete. I understand that any false information or omission maydisqualify me from further consideration for employment and may result in mydismissal if discovered at a later date. I authorize and agree to cooperate ina thorough investigation of all statements made herein and other mattersrelating to my background and qualifications. I understand that anyinvestigation conducted may include a request for employment and educationalhistory, credit reports, consumer reports, investigative consumer reports,driving record, and criminal history. I authorize any person, school, currentand former employer, consumer reporting agency, and any other organization oragency to provide information relevant to such investigation and I herebyrelease all persons and corporations requesting or supplying informationpursuant to such investigation from all liability or responsibility to me fordoing so. I understand that I have the right to make a written request within areasonable period of time for complete disclosure of the nature and scope ofany investigation. I further authorize any physician or hospital to release anyinformation which may be necessary to determine my ability to perform the jobfor which I am being considered or any future job in the event that I am hired.I understand I may be required to successfully pass a drug-screeningexamination. I hereby consent to a pre- and/or post-employment drug screen as acondition of being hired or of my continued employment, if required.

I UNDERSTAND THAT THIS APPLICATION ORSUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEEEMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT IHAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATEDAT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.

I have read, understand, and by mysignature consent to these statements.

Signature: *

Date*

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