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APPLICATION FOR EMPLOYMENT
Position applied for:
Date:
05/21/2013
Name:
Address:
Home Phone #:
Mobile Phone #:
Email Address:
(A copy of this application will be emailed to the address provided)
Are you legally eligible to work in the United States?
Are you 18 years old or older?
(If no, you may be required to provide authorization to work)
Have you every been convicted of a crime other than a minor traffic offense?
(A conviction will not necessarily disqualify you for employment. Rather, such
factors as age and date
of conviction, seriousness and nature of the crime and rehabilitation will be considered.)
If yes, please provide details (dates and location for all convictions)
Have you ever been terminated from employment or asked to resign by an employer?
If yes, please provide company names and details
Can you work overtime, including weekends?
If no, please explain
Are you able to travel by motor vehicle and/or plane?
If no, please explain
Are you able to perform the essential functions of the job for which you are applying,
with or without a reasonable accommodation?
If no, please explain
Date you can start:
Hourly Rate/Salary Desired:
Are you currently employed?
If so, may we contact your present employer?
How did you hear about us?
Have you ever worked for Novinium before?
Include your employment history starting with the most recent and working backwards
in time. Incomplete information could disqualify you from further consideration.
Do you have any special skills, experience and/or training that would enhance your
ability to perform the position? If yes, explain.
Computer Skills (please describe level of proficiency: beginner, intermediate, or
advanced)
Give the names of three direct supervisors who you have reported to.
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As an equal opportunity employer, we hire without consideration to race, religion,
creed, color, national origin, age, gender, sexual orientation, marital status,
veteran status or disability. We invite you to complete the optional self-identification
fields below used for compliance with government regulations and record-keeping
guidelines.
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Gender:
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Race:
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Veteran/Disability:
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Novinium is an equal opportunity employer and does not discriminate on the basis
of gender, age, race and color, religion, marital status, national origin, disability
or veteran status.
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Interviews are given on a competitive basis, using job-related factors, after a
written application has been received and reviewed. Because of the large number
of applications received, not everyone who applies for a vacant position will be
interviewed.
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I understand that, if selected, I will be required to provide proof of my identity
and my legal right to work in the United States prior to actual employment with
Novinium.
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I understand that any offer of employment is contingent upon passing a pre employment
drug screening and alcohol test.
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I certify that I have answered truthfully and have not knowingly withheld any information
relative to my application. I understand that a misrepresentation or material omission
on this application will result in my being eliminated from further consideration.
I further understand that, if accepted for employment, any misrepresentation or
material omission which becomes known to Novinium may result in immediate termination
of my employment.
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I authorize all previous employers and supervisors, including all persons with and
for whom I have worked, to give Novinium. representatives any and all information
regarding me and my previous employment. I release Novinium, and all previous employers
and supervisors from liability for any damages that may result from furnishing information
to Novinium.
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