Portal

Application for Employment

Equal Employment Opportunity Statement:
Employment decisions will be based on the principles of equal opportunity. All personnel actions (recruiting, hiring, training, promotion, compensation, etc.) are administered without regard to any characteristic protected by state, federal or local law, assuming said characteristic does not interfere with the performance of essential job functions. Reasonable accommodations will be made for disabilities and religious beliefs. Please inform us of any necessary accommodations to the application process.

Please review this application first, and have all materials ready. You must complete and submit in one sitting.

First Name - REQUIRED*

Last Name - REQUIRED*

Middle Name

Address - REQUIRED*

City, State, Zip - REQUIRED*

Telephone # - REQUIRED*

Position (s) Applied For

Salary Expected

APPLICANT INFORMATION

No Yes

Have you applied for a position with us before?

Yes - Specify Date

Yes No

Are you currently employed?

No Yes

Have you ever been employed with us before?

Yes - Specify Date

Previous Position

Earliest Start Date:

Full-timePart-time

Availability:

Yes No

Can you travel for work?

Yes No

Are you legally permitted to work in the U.S.?

Yes No

Are you 18 years of age or older?

NOTE: Proof of eligibility will be required within three working days of employment.

Yes No

Will you take a drug test?

EDUCATION - LIST THE LAST 3 SCHOOLS ATTENDED

1.) Name of School

Location

Years Completed:

Degree/Major

G.P.A.

Yes No

Diploma Obtained?

2.) Name of School

Location

Years Completed:

Degree/Major

G.P.A.

Yes No

Diploma Obtained?

3.) Name of School

Location

Years Completed:

Degree/Major

G.P.A.

Yes No

Diploma Obtained?

1.) Employer

EMPLOYMENT HISTORY

Supervisor

Address

Phone

Position Title and Duties

Starting Date

Ending Date

Starting Pay

Ending Pay

Why did you leave this job?

Yes No Later

May we contact this employer?

2.) Employer

Supervisor

Address

Phone

Position Title and Duties

Starting Date

Ending Date

Starting Pay

Ending Pay

Why did you leave this job?

Yes No Later

May we contact this employer?

3.) Employer

Supervisor

Address

Phone

Position Title and Duties

Starting Date

Ending Date

Starting Pay

Ending Pay

Why did you leave this job?

Yes No Later

May we contact this employer?

APPLICANT'S STATEMENT

I certify that the information provided in this application is true, to the best of my knowledge.
I understand that providing false or misleading information at any time during the application and interview process may lead to refusal to hire or discharge from the Company. If I become employed by the Company, I agree to follow all rules and regulations of the Company as they develop and change.
I allow the Company to conduct investigations on me, my background and my performance, and am aware that such investigations will become a part of my employment record. With this, I authorize the Company to speak with my acquaintances, personal and professional, to gather information about me.
I authorize all former employers and references to provide any information about me to the Company, and release them of liabilities and damages of all kinds for providing this information. I authorize the Company to verify the accuracy of the information within this application. I also authorize the release of my educational transcripts to the Company for education verification purposes.
I release Adams Remco, Inc. from liability for collecting information about me and using it to make employment decisions.
If I become employed by the Company, I understand that the employment relationship will be “at will,” and that the “at will” status may not change at any time unless specifically approved, in writing, by the CEO of the Company.
I agree that if I become indebted to the Company, I will be responsible for repaying the total owed upon termination from the Company. If I do not repay the sum prior to my final paycheck being received, the money owed will be deducted from my pay.
This application for employment is valid for the next 90 days. I understand that if I wish to be considered for employment after this period of time, I must apply again.

Date: Required*

Click below to upload resume, samples, etc.

E-mail Address

Alternate Phone

In accordance with the Electronic Records and Signatures in Commerce Act of 2000, entering your initials below and entering a date constitutes acceptance of and agreement to the terms and conditions stated in this document.

Initials: Required*

Select Office Location*

Class Code

Yes No

Do you have any felony conviction(s) not expunged or sealed by a court? (If yes, explain)

Yes No

Have you ever been fired/asked to resign from a job? (If yes, explain)

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