EMPLOYMENT APPLICATION FORM PROJECT ARCHIMEDES LLC,

Transcription

1 EMPLOYMENT APPLICATION FORM PROJECT ARCHIMEDES LLC, (Notice to Applicants :) All information requested in this application must be filled out completely, and applicants may attached such certificates, resumes, records, educational transcripts, or other relevant information in a separate document with their name and SSN at top of each page. DO NOT state in your application to SEE RESUME, as you are required to sign and date this controlled document, and failure to complete this application in total will result in its refusal for consideration. Project Archimedes LLC, is in full compliance with EEOC requirements of state, federal and all protected status applicants, and is pro-active to fair employment standards. COMPLETED APPLICATIONS MAY BE MAILED TO OR ED AS INDICATED HERE PROJECT ARCHIMEDES LLC, ATTN: HR DEPT 509 SW 17 TH STREET FORT LAUDERDALE, FL projectarchimedes@yahoo.com All information contained in this application is the sole property of Project Archimedes LLC, and used exclusively for the functions of employee control and information. No information shall be released nor provided any outside force or agency without court order or effected employee written release.

2 GENERAL INFORMATION APPLICANT: Full Name of Applicant (Printed) Social Security Number / ID Current Status Residency US Citizen Green Card Work Permit Student Current Residence Address Current City / State/ Zip Your Telephone Contact Number (Note :) You must provide proof of your residency status at time of interview with HR. Make sure to have clear copies for presentation. POSITION/S APPLYING FOR: Applicants may apply for up to five (5) positions within our company with a single application. Please indicate the order of preference from top to bottom, and specify title of position and our job description number from upper right hand corner. Please do not list any available position in this section. POSITION TITLE JOB CODE FORMAL EDUCATION & TRAINING SCHOOLS Applicants may list any and all education, certificates of training, trade school completions or any recognized professional instruction received in this section. Please be specific in AWARD Section as degree/license/certificate SCHOOL or FACILITY DATES INCLUSIVE STUDY TITLE AWARD PROFESSIONAL ORGANIZATIONS CURRENT Applicants should list any and all current organizations, alumni, unions, or professional credentials currently held: Credential or Organization Date Acquired Credential or Organization Date Acquired

3 ABOUT YOUR SECURITY ELEGIBILITY BACKGROUND: The information required here serves as a background to your potential security classification only in the company operations workforce or to specific contractual requirements of the company. All questions and reply should be a matter of public record. Answer should be specific without explanation. In end result one word only each question: Convicted / Exonerated / Current / Pending or NA (Not Applicable). INFORMATION LAST DATE OF ISSUE OFFICIAL REASON STATED END RESULT More Than 3 Misdemeanors Felony Convictions Civil Action Non-Property Ever Refused Passport Ever Failed Security Check INS Immigration Issues Organizational Affiliation SPECIAL SKILL SETS YOU HAVE List in this section any special skill sets you have which could benefit the company. Languages, computer programs proficiency, sport participations, civil program participations, special talents etc: List only those proficient in. SKILL ABILITY HOW LONG LAST USED OPTIONAL ANSWER QUESTIONS APPLICANTS: The company is pro-active in many programs sponsored by recognized groups, and your answer to these questions is optional only, but provides the company with a basis to modify many work related positions to accommodate those various functions. Answers here are purely volunteer, but will assist HR in position placement to best suit your position classifications should you be offered employment 1. Do you participate in any organized substance abuse classes YES NO 2. Do you require daycare schedule consideration for child supervision YES NO 3. Do you participate in community volunteer Work Assignments YES NO 4. Are you a active member of the National Guard or Reserve Unit YES NO (Note: if you fail to identify issue here, we may not be able to be accommodated after hire) EMERGENCY CONTACT INFORMATION NAME RELATIONSHIP TELEPHONE LOCATION STATE

4 EMPLOYMENT HISTORY Please provide employment history for last 10 years. Applicants should start with current employment period, and if unemployed simply state same. If list any employment as self/consultant/ or school you may be required to provide proof. We understand and are aware of the economic and employment environment; any misstatement of fact can result in not being hired or termination after hired. We do not contact your current employer in verifications

5 DO YOU HAVE A RESUME ATTACHED THIS APPLICATION YES NO DO YOU HAVE OTHER DOCUMENTS ATTACHED YES NO

6 EXPLAIN YOUR CAREER OBJECTIVE: Please provide us with an insight as to your career or job objectives in the next five year period. This space is provided for applicants to express in their words where they see themselves in our Company future: SPECIAL OR PROTECTED STATUS DECLARATION: (If Applicable) If you are applying for a position within Project Archimedes under the federally mandated special or protected status classification please provide the following information for processing. If more than one please list all STATUS DECLARATION ISSUE DATE AWARDED PERMANENT OR TEMPORARY CONTROL OFFICE LOCATION CONTACT CASE MANAGER TELEPHONE STATUS DECLARATION ISSUE DATE AWARDED PERMANENT OR TEMPORARY CONTROL OFFICE LOCATION CONTACT CASE MANAGER TELEPHONE STATUS DECLARATION ISSUE DATE AWARDED PERMANENT OR TEMPORARY CONTROL OFFICE LOCATION CONTACT CASE MANAGER TELEPHONE Notice to Applicants eligible: If you choose not to declare protected status in this declaration, and waive such entitlement for your employment consideration, then you shall waive any challenge by law should you take issue with company. If you are entitled then please fill out this section.

7 YOUR BACKGROUND PROFILE: The purpose of this section is to provide the company additional information about yourself, and to assist in job assignment and special program placement into any available programs within the company. The information makes company aware of your job related flexibility. DATE OF BIRTH BIRTH LOCATION BIRTH NAME IN 10 YEARS HOW MANY TIMES MOVED DO YOU HAVE A VALID VEHICLE LICENSE NUMBER SCHOOL AGE CHILDREN HOW LONG OUT OF WORKFORCE CAN YOU TRAVEL FOR COMPANY WOULD YOU CONSIDER RELOCATION MARRITAL STATUS DO YOU HAVE VALID PASSPORT DO YOU PLAN WORK SECOND JOB HOW WILL YOU GET TO WORK DO YOU HAVE FAMILY OUTSIDE USA WHEN CAN YOU BEGIN WORK MEDICAL ALERT OR CONDITION INFORMATION: This information has nothing to do with your eligibility for employment, but deals directly to specific known chronic medical assistance conditions if hired which will quickly allow staff and emergency units to assist you. The information provided here will be placed on the back of your company identity badge. YES or NO answer only please CRONIC ASTHMA DO YOU CARRY MEDICATION HEART CONDITION DO YOU CARRY MEDICATION EPILEPSY ATTACKS DO YOU CARRY MEDICATION OTHER SEIZURE DO YOU CARRY MEDICATION APPLICANT REFERENCES: Please provide two professional references and two personal references which may be contacted. FULL NAME RELATIONSHIP TELEPHONE

8 APPLICANT AUTHORIZATION AND DECLARATION ACKNOWLEDGMENT AND AUTHORIZATION OF APPLICANT FOR PRE-EMPLOYMENT VERIFICATIONS I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. The company may conduct credit checks on those who have access to company accounts in their position, but do not otherwise conduct such checks for employment. I further understand my employment or continued employment may be conditional on consenting to random drug testing or security clearance, or bonding, or all, and give such consent by signature here-in. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an at will nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this at will employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I understand that my personal information will not be provided to any source unless legal court order is presented, and that verification of employment will be provided only after 90 days of employment, unless a signed release for verification is made by me in writing. For purposes of Human Resources Administration Only, Garnishment of Income may be sent for: (Mark all that apply) Child Support IRS Judgment Assignment (completing this part has no bearing on employment, but is for administrative purposes only if hired) In the event of employment, I understand that false, intentional omission or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer, as contained in the employee handbook or written employment amendments. Signature of Applicant Date Replace company logo here with a GIF, JPG or TIFF file picture of yourself BE SURE TO READ YOUR APPLICATION CAREFULLY, INCLUDE ALL DOCUMENTATION YOU WANT CONSIDERED AND AGREE TO ALL CONDITIONS BEFORE SIGNING

9 This application for employment shall be considered active for a period of time not to exceed 180 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. Applicants (Do Not Enter Information Here) This Space Is For HR Use Only Human Resources INTERVIEWER DATE NOTES Validations & Background Departmental Technical Skill Test HUMAN RESOURCES AUTHORIZED OFFER: POSITION OFFER COMPANY CODE EEOC - JOB BASE SALARY / RATE PH DEPARTMENT EMPLOYEE STATUS BONUSES START DATE STATE/FEDERAL INCENTIVES MEDICAL CONTRIBUTION EMPLOYEE ACCEPTANCE DATE PROTECTED STATUS TOTAL EMPLOYEE PACKAGE Human Resource Director authorization: Date: By: EMPLOYEE IDENTIFICATION NUMBER: