Employment Application Equal Employment Opportunity Policy: We are committed to providing equal employment opportunities to all employees and applicants without regard to age, race, color, national origin, sex, religion, disability, citizenship status, service member status in accordance with all applicable federal, state and local laws. Position Desired Date Desired Pay Rate Social Security Number * Personal Information Full Legal First Name * Middle Name (Type N/A if you don't have a legal middle name) * Full Legal Last Name * Present Address * City * State * AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code * How long have you lived there? (If less than 7 years please complete previous address section) Years * 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Months * 0 1 2 3 4 5 6 7 8 9 10 11 12 Previous Address City State AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code How long did you lived there? Years 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Months 0 1 2 3 4 5 6 7 8 9 10 11 12 Date of Birth * Home Phone Email Address * Have you ever worked for SearchPros before? * Yes No If yes, identify dates and the Companies you were sent on assignment if any: CRIMINAL HISTORY SearchPros will provide you with a release form that complies with the Fair Credit Reporting Act and any applicable state law if needed. Please take note of all applicable restrictions to your location, and only answer questions as instructed. Question One: Do not Answer this question if you are applying to work in: Illinois; Massachusetts; Minnesota; New Jersey; Oregon; Seattle, WA; San Francisco, CA; Los Angeles, CA; Philadelphia, PA; New York City, NY; Buffalo, NY; Rochester, NY; Columbia, MO; Baltimore, MD; Montgomery County, MD; Prince George’s County, MD; or Washington, D.C. Have you ever plead no contest, nolo contendere, or guilty to a misdemeanor crime, or been convicted of a misdemeanor crime? Yes No Question Two: Do not Answer this question if you are applying to work in: Illinois; Massachusetts; Minnesota; New Jersey; Oregon; Seattle, WA; San Francisco, CA; Los Angeles, CA; Philadelphia, PA; New York City, NY; Buffalo, NY; Rochester, NY; Columbia, MO; Baltimore, MD; Montgomery County, MD; Prince George’s County, MD; or Washington, D.C. Have you ever plead no contest, nolo contendere, or guilty to a felony crime, or been convicted of a felony crime? Yes No NOTE: Answering “yes” to either of these questions does not constitute an automatic bar to employment. SearchPros will consider the nature of the crime, its seriousness, the substantial relation to the position’s functions and qualifications, the number of occurrences, the applicant’s age at the time of the crime, the time elapsed since the crime, the applicant’s entire work and educational history, employment references and recommendations, and the business necessity of any exclusion when required by law. If you answered yes to either of the two preceding questions, please give dates and details for each incident: RECORD OF PREVIOUS EMPLOYMENT Please list the names of your present or previous employers (past 7 years only) in chronological order with present or most recent employer listed first. Be sure to account for all periods of time including any period of unemployment. If self-employed, give firm name and supply business references. Current / Most Recent Employer Employer * Present Last Employer Employer Name * Address * City * State * AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code * Telephone * Employed From * Employed To * Starting Pay * Final Pay * Your Title or Position * Name and Title of Last Supervisor * Reason for Leaving * Employment 2 Employer Present Last Employer Employer Name Address City State AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code Telephone Employed From Employed To Starting Pay Final Pay Your Title or Position Name and Title of Last Supervisor Reason for Leaving Employment 3 Employer Present Last Employer Employer Name Address City State AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code Telephone Employed From Employed To Starting Pay Final Pay Your Title or Position Name and Title of Last Supervisor Reason for Leaving Employment 4 Employer Present Last Employer Employer Name Address City State AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code Telephone Employed From Employed To Starting Pay Final Pay Your Title or Position Name and Title of Last Supervisor Reason for Leaving Have you ever been terminated or asked to resign from any job? Yes No If yes, please explain circumstances: PLEASE EXPLAIN FULLY ANY GAPS IN YOUR EMPLOYMENT HISTORY: May we contact your current employer/supervisor listed above? Yes No If No, please explain: Please indicate any specific experience, special training and qualifications that you have which you feel are relevant to the position for which you are applying. Have you ever used another name? * Yes No If yes, please list all names utilized and dates of utilization Is any additional information relative to change of name, use of an assumed name, or nickname necessary to enable a check on your work and educational record? * Yes No If yes, please explain: If hired, can you furnish proof that you are over 18 years of age? * Yes No If hired, can you furnish proof that you are legally authorized to work in the U.S.? * Yes No Do you have adequate transportation to and from work? * Yes No EDUCATION Have you obtained a High School Diploma? * Yes No Name of High School Address of School Date of Graduation Name utilized in school Please provide the school, university or college name (highest level of education received) Institution Location Degree Major / Minor Name Used While Attending Attendance Dates Trade or Correspondence: Diploma/Degree Describe Course of Study or Major Describe Specialized Training, Experience, Skills, Certifications, Licenses, etc. Other: AVAILABILITY Are you willing to work a varied schedule, including nights, weekends, holidays and/or overtime? Yes No Please indicate the dates you are NOT available to work: Please indicate dates you are NOT available to work: EMERGENCY CONTACT In case of emergency, please give us additional contact information: Contact #1: Name * Relationship * Complete Address * Phone #1: * Alternate Phone: * Contact #2 Name Relationship Complete Address Phone #1: Alternate Phone: INDUSTRY-SPECIFIC EXPERIENCE Do you have experience and/or training in any specific industry? Yes No If yes, Please describe: APPLICANT'S STATEMENT & AGREEMENT 1. In the event of my employment in a position with SearchPros Staffing, LLC (the “Company”), I will comply with all rules and regulations of this Company. I understand that the Company may require me to submit to a test for the presence of drugs in my system prior to employment and at any time during my employment, to the extent permitted by law. I also understand that any offer of employment may be contingent upon the passing of a physical examination. I consent to the disclosure of the results of any physical examination and tests related to the Company. I also understand that I may be required to take other tests such as personality and honesty tests, prior to and during my employment. I understand that should I decline to sign this consent or take any of the above tests my application for employment may be rejected or my employment may be terminated. I understand that bonding may be a condition of hire. If it is, I will be so advised either before or after hiring and a bond application will have to be completed. 2. I further understand that the Company may contact my previous employers. I authorize those employers to disclose to the Company all records and information pertinent to my employment with them. In addition to authorizing the release of any information regarding my employment, I hereby waive any rights or claims I have or may have against my former employers, their agents, employees, and representatives, as well as other individuals who release information to the Company, and release them from any and all liability, claims, or damages that may directly or indirectly result from the use, disclosure, or release of any such information by any person or party, whether such information is favorable or unfavorable to me. I authorize the persons named herein as personal references to provide the Company with any pertinent information they may have regarding myself. I also authorize the Company to use social medial and other internet resources as part of the pre-employment screening process to the extent permitted by law. 3. I hereby state that all the information that I have provided on this application or any other documents completed in connection with my employment, and in any interview, is true and accurate. I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that if I am employed and any information provided to the Company is found to be false or incomplete in any respect, I may be dismissed. I understand if selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard. 4. I agree that the Company and I will both utilize binding arbitration as the sole and exclusive means to resolve all disputes that may arise out of or be related in any way to my employment and/or application for employment, including but not limited to the termination of my employment and my compensation. The Company and I each specifically waive and relinquish our right to bring a claim against the other in a court of law. Both the Company and I agree that any claim, dispute, and/or controversy that I may have against Company (or its owners, directors, officers, managers, employees, or agents), or the Company may have against me, shall be submitted to and determined exclusively by binding arbitration under the Federal Arbitration Act (“FAA”), and, the extent they do not conflict with the terms of this Agreement. The FAA applies to this agreement because the Company’s business involves interstate commerce. Included within the scope of this Agreement are all disputes, whether based on tort, contract, statute (including, but not limited to, any claims of discrimination, harassment and/or retaliation, whether they be based on Title VII of the Civil Rights Act of 1964, as amended, the Age Discrimination in Employment Act, the Americans with Disabilities Act, the Family and Medical Leave Act, or any other state or federal law or regulation), equitable law, or otherwise. The only exception to the requirement of binding arbitration shall be for claims arising under the National Labor Relations Act that are brought before the National Labor Relations Board, claims for unemployment compensation benefits, claims for medical and disability benefits and/or claims under the state workers’ compensation law, or as may otherwise be required by state or federal law. However, nothing herein shall prevent me from filing and pursuing proceedings before the United States Equal Employment Opportunity Commission (although if I choose to pursue a claim following the exhaustion of such administrative remedies, that claim would be subject to the provisions of this Agreement). By this binding arbitration provision, both the Company and I give up our right to trial by jury of any claim I or the Company may have against each other. 5. All claims brought under this binding arbitration agreement shall be brought in the individual capacity of myself or the Company. This binding arbitration agreement shall not be construed to allow or permit the consolidation or joinder of other claims or controversies involving any other employees, or permit such claims or controversies to proceed as a class action, collective action, private attorney general action or any similar representative action. No arbitrator shall have the authority under this agreement to order any such class or representative action. By signing this agreement, I am agreeing to waive any substantive or procedural rights that I may have to bring an action on a class, collective, private attorney general, representative or other similar basis. 6. I acknowledge that this agreement is not intended to interfere with my rights to collectively bargain, to engage in protected, concerted activity, or to exercise other rights protected under the National Labor Relations Act, and that I will not be subject to disciplinary action of any kind for opposing the arbitration provisions of this Agreement. 7. In addition to any other requirements imposed by law, the arbitrator selected shall be a retired federal judge or judge of the state court of general jurisdiction, or an otherwise qualified individual to whom the parties mutually agree, and shall be subject to disqualification on the same grounds as would apply to a judge of such court. The arbitrator shall follow and observe the Federal Rules of Civil Procedure and the Federal Rules of Evidence, and all rules of pleading (including the right to file a Motion to Dismiss), all rules of evidence, all rights to resolution of the dispute by means of motions for summary judgment, judgment on the pleadings, and directed judgment or non-suit shall apply and be observed. The arbitrator shall have the immunity of a judicial officer from civil liability when acting in the capacity of an arbitrator, which immunity supplements any other existing immunity. Likewise, all communications during or in connection with the arbitration proceedings shall be considered privileged. As reasonably required to allow full use and benefit of this agreement, the arbitrator shall extend the times set for the giving of notices and setting of hearings. Awards shall include the arbitrator’s written reasoned opinion. Resolution of all disputes shall be based solely upon the law governing the claims and defenses pleaded, and the arbitrator may not invoke any basis (including but not limited to, notions of “just cause”) other than such controlling law. 8. I have received my copy of the Company’s employee handbook. I understand and agree that it is my responsibility to read and familiarize myself with the policies and procedures contained in the handbook. I understand and agree that nothing in the employee handbook creates or is intended to create a promise or representation of continued employment and that employment at SearchPros is employment at will; employment may be terminated at the will of either the Company or myself. My signature certifies that I understand that the foregoing agreement on at-will status is the sole and entire agreement between SearchPros and myself concerning the duration of my employment and the circumstances under which my employment may be terminated. It supersedes all prior agreements, understandings, and representations concerning my employment with SearchPros. I understand that except for employment at-will status, any and all policies or practices can be changed at any time by the Company. SearchPros reserves the right to change my hours, wages, and working conditions at any time. I understand and agree that other than the president of SearchPros, no manager, supervisor, or representative of the Company has authority to enter into any agreement, express or implied, for employment for any specific period of time, or to make any agreement for employment other than at-will; only the president has the authority to make any such agreement and then only in writing, signed by the president. 9. I agree that, if hired, my employment shall not be for any specific duration and either the Company or I may terminate my employment relationship at any time, with or without cause and/or with or without prior notice. This express at-will acknowledgement supersedes any and all prior representations or understandings, whether written or oral, express or implied, between the Company and me. 10. This is the entire agreement between myself and the Company regarding dispute resolution, the length of my employment, and the reasons for termination of my employment, and this agreement supersedes any and all prior agreements regarding these issues. Oral representations or agreements made before or after my employment do not alter this Agreement. 11. If any term or provision, or portion of this Agreement is declared void or unenforceable it shall be severed and the remainder of this Agreement shall be enforceable. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT & AGREEMENT. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK A COMPANY REPRESENTATIVE BEFORE SIGNING. I HEREBY ACKNOWLEDGE THAT I HAVE READ ALL THE ABOVE STATEMENTS AND UNDERSTAND AND AGREE TO THE SAME. By digitally signing this form and supplying my social security number, I agree that all the information is accurate and true. If you have any questions regarding these policies, please discuss it with your SearchPros Representative. Signature * Draw It Type It Clear Date * reCAPTCHA Resume Upload * Uploading Files. Please Wait. It may take a minute to send. Do not resubmit or close until completed.