Online Application

Name*

First Last

Date

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Have you ever worked for The PLUS Company before?

Yes

No

Are you interested in:

Full Time

Part Time

Per Diem

How did you hear about this position?

Please select availability

Day

Evenings

Weekends

Any

Employment History

Company Name

From (mo./yr)

To (mo./yr)

Supervisor

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Department/Position/Duties

Final Wage

Reason for Leaving

May we contact this employer?

Yes

No

Employment History 2

Company Name

From (mo./yr)

To (mo./yr)

Supervisor

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Department/Position/Duties

Final Wage

Reason for Leaving

May we contact this employer?

Yes

No

Education

Highest Education Level Completed

School/College and City/State

Diploma/Degree

Major area of study

Specialized Training Relevant to the Desired Position

Professional License(s), Registration(s) or Certification(s)

Name

Number

Issued By

Type

License

Registration

Certification

Name

Number

Issued By

Type

License

Registration

Certification

Name

Number

Issued By

Type

License

Registration

Certification

Other Type of Credential, Please Specify.

Other Information

Do you have a current Driver's License (if required for the job.)

Yes

No

State of Issue

License Number

Have you ever been convicted of a criminal offense, other than a traffic violation, that has not been annulled by the court?

Yes

No

Such a conviction may be relevant if job related, but does not necessarily bar you from employment.

Professional/Business References

Name

Company

Phone

Title

Relationship

Reference 2

Name

Company

Phone

Title

Relationship

Please Read Carefully Before Signing

I certify that the statements contained on this application are true. I understand that false or misleading statements on this or any other application materials are grounds for immediate dismissal.
I agree that a thorough investigation of my background may be made and I authorize my former employers and other persons or organizations to provide any information that they have about my background. I release all concerned from any liability in connection therewith.
I understand that if offered a position, I will be required to have a pre- placement occupational examination to determine my ability to perform the essential functions of the position, authorize a check of criminal conviction records and submit employment eligibility proof required by the Immigration and Naturalization Service.
I also understand and agree that if I am employed by The PLUS Company, Inc. my employment is terminable at will, with or without notice or cause by either party. Not withstanding any oral or written statements by The PLUS Company, Inc. prior to, at, or following my date of employment unless set out in writing, dated and executed by both parties.
If hired, I agree to be bound by all policies, rules and regulations of my employer.
I understand that only Human Resources is authorized to act as an agent of the employer with respect to terms, conditions and offers of employment.

Signature

Date

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