MPi Business Online Employment Application

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

First Name:

Last Name:

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

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

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:

Name:

REFERENCES

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

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

Branch:

From (MM/YYYY):

To (MM/YYYY):

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

OFFICE SKILLS

Typing W.P.W. :

PC Hardware Skills :

PC Software Skills:

What other office equipment do you operate?:

DISCLAIMER AND ACCEPTANCE

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.