Scott HR Employment Application

Employment Application

Each question should be answered completely and accurately. Verification of eligibility to work in the U.S. will be required if an employment offer is made. Thank you for applying through Scott Human Resources.
Date of Application

MonthDayYear
Date
Name:*

First NameLast Name
Other Names You Use (First and Last)
Nicknames, Maiden Names, and Other Names You Use
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*

Area CodePhone Number
E-mail Address:*

Confirmation Emailexample@example.com
Company applying for:
Are you applying for a position with DuBois Consultants or KONZA?*

Yes, DuBois ConsultantsYes, KONZANo, another company
Name of Company applying for:
Company applying for:*
Position(s) applying for:*
Expected Pay*
Salary or Hourly Rate?*
How were you referred to us?*

EmployeeIndeed.comFacebookTwitterCraigslistOther
Have you applied here before?*

YesNo
If yes, please give date:
Are you available to work?*

Full TimePart TimeShift WorkTemporary
Are you over the age of 18?*

YesNo
Are you eligible to work in the United States?*

YesNo
Are you fluent in a foreign language? (if applicable)*

YesNo
If yes, what language(s)?
Are you currently employed?*

YesNo
What date are you available to begin work? *

MonthDayYear
Date

JOB SKILLS & TRAINING
Describe your skills:*
Training or Certifications:
List any additional information you would like us to consider:

REFERENCES
References

Please list two references you have known for at least one year and are familiar with your work life. Provide the best telephone phone to reach each contact.
Reference 1
Name:*

First NameLast Name
Company:*
Phone Number*

Area CodePhone Number
Years Known:*
Relationship to you:*
Reference 2
Name:*

First NameLast Name
Company:*
Phone Number*

Area CodePhone Number
Years Known:*
Relationship to you:*

EMPLOYMENT HISTORY
Employment History

Start with your most recent employer and provide all information.
Employer 1
Employer 1:*
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Pick a future date if you currently work here.
Position Held:*
Supervisor:*
May we contact for reference?*

YesNoLater
Supervisor Direct Phone*

Area CodePhone Number
Supervisor Email
example@example.com
Starting Salary:*
Ending Salary:*
Responsibilities:*
Reason for leaving:*
What did you like most about your position? *
What did you like least about your position? *
Employer 2
Employer 2:
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Position Held:
Supervisor:
May we contact for reference?

YesNoLater
Supervisor Direct Phone

Area CodePhone Number
Supervisor Email
example@example.com
Starting Salary:
Ending Salary:
Responsibilities:
Reason for leaving:
What did you like most about your position?
What did you like least about your position?
Employer 3
Employer 3:
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Position Held:
Supervisor:
May we contact for reference?

YesNoLater
Supervisor Direct Phone

Area CodePhone Number
Supervisor Email
example@example.com
Starting Salary:
Ending Salary:
Responsibilities:
Reason for leaving:
What did you like most about your position?
What did you like least about your position?

MILITARY SERVICE RECORD
Branch of Service:
Discharge date:

MonthDayYear
Date
Discharge rank:

ATTACHMENTS
You have the option to upload a resume and a cover letter. Some positions require a cover letter. Please review the requirements in the job posting.
Upload Resume and Cover Letter

Browse Files
Some positions require a cover letter. Please double check job requirements. Cancelof

SIGN TO AUTHORIZE & SUBMIT
For the purposes of this document, a typed signature will serve as the official signature.
Signature:*
Today's Date*

MonthDayYear
Date
I understand that Scott Human Resources is not making an employment offer at this time. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment or for termination, if employed.

I authorize Scott Human Resources to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, credit history, driving record, and other relevant information, if job-related. I give my full consent for all contacted individuals, including current or former employers, to provide information concerning this application, and I waive my right to bring any cause of action against these individuals for any and all liability for damages arising from furnishing the requested information to Scott Human Resources. I acknowledge that a facsimile or photocopy of this form is as valid as the original.

Offers of employment are contingent upon finalizing pre-employment actions which may include: drug test and/or physical examination, or other items may be required. Scott Human Resources may withdraw an offer of employment any time for any reason prior to the original agreed upon start date, or after should results come back later.

I understand that this application is current for 60 days. At the conclusion of this time, if I have not heard from Scott Human Resources and still wish to be considered for employment, it will be necessary to complete a new application.

I understand that if I am hired, my employment at Scott Human Resources is “at will” and may be terminated by myself or by them at any time, with or without cause or notice, for any reason or for no reason. I understand that no representative of Scott Human Resources has the authority to make any assurance to the contrary.

Equal Employment Opportunity Compliance

Applicants are considered regardless of race, color, religion, gender, national origin, pregnancy, age, disability, veteran status, or any other legally protected status.
Please verify that you are human*
Should be Empty: