Online Employment And Entrepreneurial Training Application

COMPANY APPLICATION WILL BE SUBMITTED THROUGH

3 D ECONOMIC DEVELOPMENT CONSORTIUM PLATINUM STAFFING AND REFERRAL SERVICE CREATIVE ECONOMIC DEVELOPMENT SYSTEM PRIMARY GROUP, INC BREAKING BARRIERS NETWORK

ARE YOU 18 OR OLDER?

YES NO

ARE YOU A VETERAN?

YES NO

ARE YOU ENTITLED TO WORK IN THE UNITED STATES?

YES NO

CURRENT HOUSEHOLD INCOME

HAVE YOU BEEN CONVICTED OF A FELONY OR BEEN INCARCERATED IN CONNECTION WITH A FELONY IN THE PAST SEVEN YEARS?

YES NO

EMPLOYMENT INFORMATION

CURRENT EMPLOYMENT STATUS

WHAT POSITION ARE YOU APPLYING FOR?

HOW DID YOU HEAR ABOUT THIS POSITION?

EXPECTED HOURLY RATE

EXPECTED WEEKLY EARNINGS

DATE AVAILABLE TO START

PREVIOUS WORK EXPERIENCE

CURRENT OR MOST RECENT WORK EXPERIENCE -1

IMMEDIATE SUPERVISOR

DATES OF EMPLOYMENT (FROM - TO)

MAY WE CONTACT?

YES No

PREVIOUS WORK EXPERIENCE -2

if previous experience is less than 2 years

IMMEDIATE SUPERVISOR

DATES OF EMPLOYMENT (FROM - TO)

MAY WE CONTACT?

YES No

IMMEDIATE SUPERVISOR

DATES OF EMPLOYMENT (FROM - TO)

MAY WE CONTACT?

YES No

HOW MANY YEARS COMPLETED?

DID YOU GRADUATE?

YES NO

HOW MANY YEARS COMPLETED?

DID YOU GRADUATE?

YES NO

TRADE SCHOOL OR CERTIFICATION PROGRAM

HOW MANY YEARS COMPLETED?

DID YOU GRADUATE?

YES NO

BY TYPING MY NAME IN THE SIGNATURE BOX, I HEREBY CERTIFY THAT THE ABOVE INFORMATION, TO THE BEST OF MY KNOWLEDGE, IS CORRECT. I UNDERSTAND THAT FALSIFICATION OF THIS INFORMATION MAY PREVENT ME FROM BEING HIRED OR LEAD TO MY DISMISSAL IF HIRED. I ALSO CONSENT TO HAVING MY FORMER EMPLOYER CONTACTED REGARDING MY WORK EXPERIENCE.