MPi Business  
         
 
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Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation, or any other characteristic protected by law. We are an equal opportunity employer.

The field descriptions in RED text are required.
 
Personal Information
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First Name: Last Name: MI
Address: City:
State: Zip:
E-mail: Primary Phone:
Are you a legal citizen of the U.S.?:
Yes No
Are you at lest 18 years old?:
Yes No
Visa Type: Alien Registration Number:
Have you ever been convicted of a crime (felony)?: Yes No
If yes, explain:
(Convictions are not automatic bar to employment)
Employment Goals
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Desired Position:
 
If Other:
Type of Employment: Location Desired:
Attach resume:
ACCEPTABLE FORMATS: .doc, .txt, .docx, .rtf, .pdf
Date Available: Desired Salary:
Willing To Travel?:
Yes No
Willing To Accept Field Assignment?:
Yes No
Interested In A Foreign Assignment?:
Yes No
What Prompted Your Application?:
Ad Employee Referral Company Reputation
Employment Agency All The Above
Education
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School Name & Completion Date Address Diploma/Degree
High School
Address
From
To
Did you graduate?
Yes No
Diploma or GED?
 
College/University
Address
From
To
Did you graduate?
Yes No
Degree
Other
Address
From
To
Did you graduate?
Yes No
Degree
PROFESSIONAL LICENSES/CERTIFICATIONS: PROFESSIONAL MEMBERSHIPS:
(Do not name any society indicating religion, race or national origin)
Name:
Name:
Name:
 
REFERENCES
1
List 3 individuals familiar with your job qualifications (No relatives or personal friends).
1.) Full Name: Relationship:
Company: Phone:
Address:
2.) Full Name: Relationship:
Company: Phone:
Address:
3.) Full Name: Relationship:
Company: Phone:
Address:
 
PREVIOUS EMPLOYMENT
1
Please list chronologically, beginning with most recent experience.
Company: Phone:
Address/City: Supervisor:
Job Title:
Starting Salary: Ending Salary:
Responsibilities:
From (MM/YYYY): To (MM/YYYY):
Reason for Leaving:
May we contact your previous supervisor for a reference?: Yes    No  
 
Company: Phone:
Address/City: Supervisor:
Job Title:
Starting Salary: Ending Salary:
Responsibilities:
From (MM/YYYY): To (MM/YYYY):
Reason for Leaving:
May we contact your previous supervisor for a reference?: Yes    No  
 
Company: Phone:
Address/City: Supervisor:
Job Title:
Starting Salary: Ending Salary:
Responsibilities:
From (MM/YYYY): To (MM/YYYY):
Reason for Leaving:
May we contact your previous supervisor for a reference?: Yes    No  
 
MILITARY SERVICE
1
 
Branch:
From (MM/YYYY): To (MM/YYYY):
Rank at Discharge: Type of Discharge:
If other than honorable, explain:
 
OFFICE SKILLS
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Typing W.P.W. : PC Hardware Skills :
PC Software Skills:    
What other office equipment do you operate?:
 
DISCLAIMER AND ACCEPTANCE
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CERTIFICATE-INQUIRY AUTHORIZATION
Please read carefully before submitting your application
I authorize investigation of all statements contained in this application including or except present employer. I hereby affirm that all statements and answers made in this application are true and correct and that I have not knowingly failed to disclose any material fact regarding my former actions or employment. Any misrepresentation by me will be sufficient cause for cancellation of the application and/or for termination from the company’s employment if I have been employed. I agree to fill out and sign all company paperwork required of a new employee and abide by company rules of conduct and safety. I understand that my employment is contingent upon meeting the field site requirements and/or medical examination, if applicable. In addition, I understand my continued employment is at the will of the company and that any other representation with respect to the term or guarantee of employment must be in writing and signed by a vice president of the company to be effective.

Check this box to certify that you have read and accept the above statement.
 
Copyright 2012 MPi Business Solutions. | All Rights Reserved.