Employment Application

Affiliated Business Consultants, Inc. is an Equal Opportunity Employer. If applicable to the Company, reasonable accommodations under the Americans with Disabilities Act will be provided as required by law.

Last Name

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First Name

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Middle Initial

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Social Security Number

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Email

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Phone

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Street Address

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City

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State

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Zipcode

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If hired, can you provide evidence of legal eligibility to work in the U.S.?

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Birthdate

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Position Desired

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Salary Desired

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Hours per week?
Full Time
Part Time

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Date you can begin work?

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Are you 18 years of age or older?
YesNo
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If under 18 years of age, you will be required to submit a birth certificate or work certificate as required by state or federal law.

Name of High School attended

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City & State

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Graduate?
YesNo
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GED?
YesNo
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Name of College or Technical School

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City & State

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Graduate?
YesNo
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Degree?

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Major?

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Are you presently enrolled in school?
YesNo
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If yes, give name & address of school and expected degree date:

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List any job-related skills or accomplishments, including military service:

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- Your Availability For Work -

Monday: Time From - To

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Tuesday: Time From - To

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Wednesday: Time From - To

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Thursday: Time From - To

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Friday: Time From - To

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Saturday: Time From - To

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Sunday: Time From - To

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Total hours per week you are available to work:

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Do you have any special requests or needs for a work schedule?

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- Give Three References That Are Not Former Employers Who We May Contact -

Reference 1:

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Reference 2:

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Reference 3:

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Your Employment History
List names of employers with present or last employer listed first.

Please note if we may not contact your present employer until after you are offered a position.

Name of Employer:

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Address:

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City, State Zip

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Job Title:

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Duties:

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Dates of Employment: From - To

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Hourly Pay or Salary: Starting Pay & Ending Pay

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Supervisor Name & Phone:

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Reason For Leaving:

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May we contact this Employer?
YesNo
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Name of Employer:

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Address:

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City, State Zip

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Job Title:

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Duties:

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Dates of Employment: From - To

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Hourly Pay or Salary: Starting Pay & Ending Pay

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Supervisor Name & Phone:

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Reason For Leaving:

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May we contact this Employer?
YesNo
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Name of Employer:

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Address:

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City, State Zip

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Job Title:

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Duties:

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Dates of Employment: From - To

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Hourly Pay or Salary: Starting Pay & Ending Pay

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Supervisor Name & Phone:

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Reason For Leaving:

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May we contact this Employer?
YesNo
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CAREFULLY READ EACH STATEMENT BEFORE SIGNING AT THE BOTTOM

I certify that all of the information provided in this employment application is true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background and credit history check. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in any immediate discharge if discovered at a later date.

I understand and acknowledge that unless otherwise defined by applicable law or written agreement with Affiliated Business Consultants, Inc., any employment relationship with Affiliated Business Consultants, Inc. is considered “employment at will”. This means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause, and with or without advance notice.

I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I have read, understand, and agree to the above statements.

Signature (*)

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Date (*)

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