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Employment Opportunities
Online Employment And Entrepreneurial Training Application
General Presentation: Pre-Employment and Certification Questionaire
Employment Overview
Employee Benefits
Accidentally Death and Dismemberment (AD&D) Insurance
Visa/Master Card Payroll Card
Employee Benefits
Accidentally Death and Dismemberment (AD&D) Insurance
Visa/Master Card Payroll Card
Social Entrepreneur Opportunities
Independent Certified PTS Consultant Agreement (ICPTSC)
Online Employment And Entrepreneurial Training Application
General Presentation: Pre-Employment and Certification Questionaire
Employment Overview
Employee Benefits
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Visa/Master Card Payroll Card
Accidentally Death and Dismemberment (AD&D) Insurance
Social Entrepreneur Opportunities
Independent Certified PTS Consultant Agreement (ICPTSC)
Consortium Partners
Strategic Partners
What Is A Strategic Partner?
Make A Pledge or Become A Partner
What Is A Strategic Partner?
Make A Pledge or Become A Partner
Contact Us
EMPLOYMENT APPLICATION
PERSONAL INFORMATION
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
FIRST NAME
MIDDLE INITIAL
LAST NAME
EMAIL ADDRESS
SOCIAL SECURITY #
SKYPE ID
STREET ADDRESS
APT/UNIT #
CITY
STATE
ZIP CODE
HOME PHONE
CELL PHONE
ARE YOU 18 OR OLDER?
YES
NO
DATE OF BIRTH
ARE YOU A VETERAN?
YES
NO
ARE YOU ENTITLED TO WORK IN THE UNITED STATES?
YES
NO
CURRENT HOUSEHOLD INCOME
less than $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
over $100,000
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
Full Time
Part Time
Self Employed
Student
Homemaker
Retired
Disabled
Unemployed
WHAT POSITION ARE YOU APPLYING FOR?
INTERNSHIP PROGRAM
EMPLOYMENT TRAINING
INDEPENDENT PTS CONSULTANT
SOCIAL ENTREPRENEUR TRAINING
FEASIBILITY STUDY REPRESENTATIVE
ADMINISTRATION
CUSTOMER SERVICE
OTHER
HOW DID YOU HEAR ABOUT THIS POSITION?
WORD OF MOUTH
FAMILY/FRIEND
WEBSITE
COMMUNITY FORUM
SOCIAL MEDIA
UNEMPLOYMENT AGENCY
OTHER
EXPECTED HOURLY RATE
EXPECTED WEEKLY EARNINGS
DATE AVAILABLE TO START
PREVIOUS WORK EXPERIENCE
CURRENT OR MOST RECENT WORK EXPERIENCE -1
EMPLOYER
IMMEDIATE SUPERVISOR
ADDRESS
PHONE NUMBER
POSITION/JOB TITLE
DATES OF EMPLOYMENT (FROM - TO)
ENDING WAGE/SALARY
REASON FOR LEAVING
MAY WE CONTACT?
YES
No
PREVIOUS WORK EXPERIENCE -2
if previous experience is less than 2 years
EMPLOYER
IMMEDIATE SUPERVISOR
ADDRESS
PHONE NUMBER
POSITION/JOB TITLE
DATES OF EMPLOYMENT (FROM - TO)
ENDING WAGE/SALARY
REASON FOR LEAVING
MAY WE CONTACT?
YES
No
EMPLOYER
IMMEDIATE SUPERVISOR
PHONE NUMBER
ADDRESS
POSITION/JOB TITLE
DATES OF EMPLOYMENT (FROM - TO)
ENDING WAGE/SALARY
REASON FOR LEAVING
MAY WE CONTACT?
YES
No
EDUCATION
HIGH SCHOOL
NAME/LOCATION
HOW MANY YEARS COMPLETED?
DID YOU GRADUATE?
YES
NO
MAJOR OR EMPHASIS
DEGREE/DIPLOMA
COLLEGE/UNIVERSITY
NAME/LOCATION
HOW MANY YEARS COMPLETED?
DID YOU GRADUATE?
YES
NO
MAJOR OR EMPHASIS
DEGREE/DIPLOMA
TRADE SCHOOL OR CERTIFICATION PROGRAM
NAME/LOCATION
HOW MANY YEARS COMPLETED?
DID YOU GRADUATE?
YES
NO
MAJOR OR EMPHASIS
DEGREE/DIPLOMA
PERSONAL REFERENCES
REFERENCE -1
NAME
ADDRESS
PHONE NUMBER
RELATIONSHIP
EMPLOYER
CO-WORKER
RELATIVE
FRIEND
OTHER
REFERENCE -2
NAME
ADDRESS
PHONE NUMBER
RELATIONSHIP
EMPLOYER
CO-WORKER
RELATIVE
FRIEND
OTHER
REFERENCE -3
NAME
ADDRESS
PHONE NUMBER
RELATIONSHIP
EMPLOYER
CO-WORKER
RELATIVE
FRIEND
OTHER
DISCLAIMER
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.
SIGNATURE (TYPE YOUR NAME)
DATE
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