Last Name:
First Name:
Middle Name:
Address:
City and State:
Zip Code:
Telephone number:
Social Security number (optional):
Position Applying For:
Shifts willing to work (Check all that apply)
first shift
second shift
third shift
Salary or Hourly Rate Expected:
Have you been employed with us before? (yes/no):
If Yes, Date:
Are you currently Employed? (yes/no):
May we contact your present employer? (yes/no):
Are you prevented from lawfully becoming employed in this country due to Visa or Immigration status? (yes/no):
(Proof of citizenship or immigration status is required upon employment.)
You are available to work:
Full Time
Part Time
Temporary
Date you can begin work:
Have you been convicted of a crime in the past seven (7) years? (Other than a traffic violation.) (Conviction will not necessarily disqualify an applicant from employment)(yes/no):
If yes, please explain:
Education please list:
List below all present and past employment, beginning with your most recent. All times must be accounted for whether employed or not.
Please include:
Describe in detail any specialized training, computer or office equipment skills, certification, licenses or:
Please list any licenses or certifications held and the dates obtained::
Please rate the following skills and abilities from 1 to 5 (best/expert).
Software
Microsoft Word:
Microsoft Excel:
Windows Vista:
Win98:
Win2000:
Adobe Acrobat:
ICAT:
Powerpoint:
Flowcharts:
Quickbooks Pro:
Quickbooks Enterprise:
Hardware
Computer Systems:
Computer Components:
Micro Controllers:
Analog Electronics:
Digital Electronics:
HW Debug Tool:
SW Debug Tool:
Programming Languages
Adobe Cold Fusion:
SQL:
Visual Basic:
C++:
FLEX:
AIR:
AS3:
Do you have or have ever held an active security clearance?:
Personal References:
APPLICANT’S STATEMENT and CONDITIONS OF EMPLOYMENT
(Please read carefully before signing.)
I certify that the answers given by me in this employment application are true, correct and complete. I agree that the company shall not be liable, in any respect, if my employment is terminated because of misstatements or pertinent omissions made by me in this application. Moreover, I understand that all offers of employment are contingent upon passing the company's background screening program in place.
I agree, as a condition of my employment, to submit to a drug screen if requested. I further agree to the search or examination of myself or personal property while on the company's premises or while conducting its business elsewhere, I also authorize any company, school, police or security personnel, or other person to give any information regarding my employment, habits, ability, or any other characteristics whatsoever, together with any information they have regarding me whether or not it is in their records. I hereby release all physicians, examiners, companies, schools, or other persons from liability for any damages whatsoever for such testing, examining, or issuing this information. It is agreed and understood that completion of this application does not mean a job opening exists and in no way obligates the company to employ me.
In the event of employment, I will comply with all company rules and regulations as established from time to time including the company's substance abuse policy. I am willing to work all work assignments as requested by the company. Furthermore, since the company does not offer contracts of employment (unless signed by the President), I understand that nothing contained herein is intended to create a contract between the company and me for either employment or the provision of any compensation or benefits. I understand that I have the right to terminate my employment at any time and likewise, the company has the same right.
I hereby understand and acknowledge that any employment relationship with this Company is of an “At-Will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time, with or without notice, with or without cause. It is further understood that this “At-Will” employment relationship may not be changed by any written document or by verbal agreement unless such change is specifically acknowledged in writing by an authorized Executive of this Company. I also understand that NSITE, LLC retains the right to amend, modify, add or delete any or all policies or procedures at its sole and absolute discretion.
During my employment with NSITE, LLC and after my employment ends, I agree not to disclose any confidential or proprietary information regarding operating and trade secrets. I further agree that with respect to any civil litigation involving NSITE, LLC in which I am a potential witness and which does not involve an actual or potential claim by me personally, I will not discuss the facts of the case with any third parties without first notifying NSITE,LLC or unless a representative or attorney of NSITE, LLC is present. A copy of this form may be used as the original. The use of results from this form and/or tests will be used for prudent employment decisions.
This application is valid for sixty days from the application date unless renewed in person or in writing.
Applicants Electronic Signature:
Date:
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
