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Application for Employment with MAY Management Services, Inc. MAY Management is a Drug Free Workplace with mandatory Drug Screening. MAY Management is also an equal opportunity employer.
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| Today's Date: | * |
| Last Name: | * |
| First Name: | * |
| Middle Initial: | |
| Present Street Address: | * |
| Present City, State and Zip: | * |
| Phone Number: | * |
| Referred By: | |
| Are you 18 years or older?: | * |
| email address: | |
| License/Certifications Held: | * |
| Are you related to anyone in our Organization, State Name, Department and Location: | * |
| In Case of Emergency, Please Notify Whom? Please supply Full Name with current address and contact number for home and cell.: | * |
| Position Applying For:: | * |
| Date Available to Start Work: | * |
| Salary Desired? Please provide either an Hourly Rate or an Annual Amount: | * |
| Are you employed Now?: | * |
| If the Answer to the above was Yes, Where? When?: | |
| Are there any days, shifts, hours you will not work?: | * |
| If the answer to the above was Yes please explain.: | |
EDUCATION
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Please provide the Name, Location, Degree/Certificate Subjects Studied and Grade Average for the following School years.
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| Grammar School: | * |
| High School: | * |
| College: | * |
| Trade, Business, Correspondance School: | * |
| Other including Graduate School: | |
BACKGROUND INFORMATION
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| Have you ever been convicted of, or pled guilty, no contest, or nolo contendere to a crime?: | * |
| If yes, provide details (date, place, offense(s), disposition, etc.: | |
| Have you ever been charged with a crime?: | * |
| Had Adjudication Withheld?: | * |
| Been Placed on a court ordered probation?: | * |
| Entered a pre-trial investigation program?: | * |
| Do you have any criminal charges now pending?: | * |
If you responded to any of the above questions in the positive please give details.
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| If yes, give details (date, place, offense(s), disposition, etc.): | |
PREVIOUS EMPLOYMENT
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| Date Month/Year (xx/xxxx): | * |
| Name, Address, Telephone# of Employer: | * |
| Position Held and Job Duties: | * |
| Salary: | * |
| Reason for Leaving: | * |
| From what month/year To What month/year: | * |
| Name, Address and Telephone# of Employer: | * |
| Position Held and Job Duties: | * |
| Salary: | * |
| Reason for Leaving: | * |
| From what month/year TO what month/year: | |
| Name, Address and Telephone# of Employer: | |
| Position Held and Job Duties: | |
| Salary: | |
| Reason for Leaving: | |
| Did you work for any of these employers under a different name?: | * |
| If Yes, which employer(s) and under what name(s)?: | |
| Please explain any gaps in your employment history.: | |
| Have you received any written reprimands/disciplinary suspension during any previous employment?: | * |
| If Yes, please explain.: | |
| Have you ever been discharged or asked to resign?: | * |
| If Yes, please explain.: | |
DRIVING RECORD.
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| Do you have a valid driver's license?: | * |
| What class of license to you possess?: | * |
| Driver's License Number: | |
| Have you ever had your license or driving privileges revoked, suspended or placed on probation?: | * |
| If Yes, please explain (include when, where and what action was taken).: | |
| How many speeding or other moving violations have you received in the last three (3) years?: | * |
| List all traffice violations (except parking) on your record for the last five (5) years.: | * |
| All motor vehicle accidents in which you were involved in the last five (5) years.: | * |
REFERENCES
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Provide names of three (3) persons (relatives and employers excluded) whom you have known at least one (1) year.
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| Name, Address, Phone#, Professional or Personal, # of Years Acquainted.: | * |
| Name, Address, Phone#, Professional or Personal, # of Years Acquainted.: | * |
| Name, Address, Phone#, Professional or Persona, # of Years Acquainted.: | * |
Employment Application Certification: I hereby certify that all of the facts and information listed on this employment application are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any such false, incomplete, or misleading information discovered on this application at any time after I am employed may result in my dismissal.
I hereby authorize the MAY Management to investigate all statements contained in this application and to interview the references and previous employers listed to give MAY Management all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise, and release all such parties from any liability which may allegedly arise from furnishing such information to MAY Management, include, but not limited to, any liability for defamation or invasion of privacy.
If I am offered employment, I understand that such an offer will be conditioned upon satisfactory results of a background investigation and/or MAY Management medical examination or inquiry, including a drug screen test. If then employed, I understand that I will be required to serve a ninety (90) day probationary period. I further understand that my employment and compensation can be terminated with or without cause or notice, at any time, regardless of the successful completion of my probationary period, at the option of either MAY Management or myself. I understand that no supervisor or other representative of MAY Management other than the President of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing,
I further understand and voluntarily agree as a condition of employment or my continued employment, that I may be requested by MAY Management to submit to a urinalysis or other drug screen test and that my failure to take such test (s) when requested to do so or unsatisfactory test results will disqualify me from consideration for employment, or if I am then employed, may result in my immediate dismissal.
In addition, in consideration of any offer of employment by MAY Management, I hereby acknowledge, understand and agree that the following will constitute terms and conditions of any such employment:
Any losses or expenses incurred by MAY Management, its clientele, or other third parties as a result of my unauthorized actions shall be immediately reimbursed to MAY Management on terms that are satisfactory and acceptable to MAY Management. To the extent permitted by law, I agree and hereby authorize MAY Management to reduce my wages for any sums owing me hereunder.
I certify that I have read, understand
and agree with the above.
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| By checking this box you are agreeing to the above statement.: | * |
| To prevent automated SPAM, please enter E9HS to submit your form (case sensitive): | * |
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