UNITED CONSOLIDATED GROUP

EMPLOYMENT APPLICATION

United Consolidated Group is an equal opportunity employer, and does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, pregnancy-related conditions, and lactation), gender identity or expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, genetic information, HIV/AIDS status, or any other characteristic protected by applicable federal, state, or local laws and ordinances

First name

Last name

Address

Phone

Email

Who referred you (if anyone)?

Are you legally eligible to work in the United States?

Yes

No

Are you at least 18 years of age?

Yes

No

Have you ever worked at United Consolidated Group before?

Yes

No

If yes, please provide dates:

Have you ever been convicted or plead guilty or “no contest” to a crime?

Yes

No

If yes, please provide provide dates and details:

Are you currently on layoff status, leave of absence, or other suspension of employment and subject to recall with another employer?

Yes

No

Employment Desired

Desired Salary/Wages

Type of Employment

Education Background

Highest Level of Education

High School

College

Graduate

Other

Did You Graduate?

Yes

No

Degree Obtained (if any)

Work History

Please provide previouse employment information for up to three (3) employers. (Employer name, phone number, address, job title, job duties, start and end dates and reason for leaving)

Employer 1: Employer name, phone number, address, job title, job duties, start/end dates and reason for leaving.

Employer 2: Employer name, phone number, address, job title, job duties, start/end dates and reason for leaving.

Employer 3: Employer name, phone number, address, job title, job duties, start/end dates and reason for leaving.

Do we have permission to contact your previous supervisor?

Yes

No

Additional Information

List any special skills or training which might be beneficial to your performance of the job for which you are applying:

References

Do not include family members or any person you live with.

Reference 1: Name, Relationship, Phone Number.

Reference 2: Name, Relationship, Phone Number.

Resume (if applicable)

By signing below, I certify that the above information is true, accurate, and complete. I understand that if this application leads to employment and I have provided false or misleading information, or if I have omitted material information, I will be subject to disciplinary action up to and including termination.

Signature

Signature field is empty.

Date

Month

Day

Year

UNITED CONSOLIDATED GROUP

Employment Desired

Education Background

Work History

Additional Information

References

Contact

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