Provocative Business and Data Consulting Solutions

EMPLOYMENT APPLICATION

NEOS is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization.

Name:
Email:

Position you are applying for:


Current Address:
City: State:
Zip Code:


Phone:
Cell:


How were you referred to this company/position?
Please indicate your last 5 year salary history:
Please indicate desired salary for this position:


If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? YesNo


If hired, are you willing to submit to and pass a controlled substance test? YesNo


Are you able to perform the essential functions of the job for which you are applying, either with/without reasonable accomodation? YesNo
If no, describe the functions that cannot be performed:
(Note: Company complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)


Have you ever been convicted of a criminal offense (felony or misdemeanor)? YesNo
If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case:


List below three persons who have knowledge of your work performance within the last five years. Please include professional supervisory references only.


Name - First, Last:
Telephone Number:
Title:
Number of Years Aquainted:


Name - First, Last:
Telephone Number:
Title:
Number of Years Aquainted:


Name - First, Last:
Telephone Number:
Title:
Number of Years Aquainted:


Please read and initial each paragraph, then sign below


I CERTIFY THAT I HAVE NOT PURPOSELY WITHHELD ANY INFORMATION THAT MIGHT ADVERSELY AFFECT MY CHANCES FOR HIRING. I ATTEST TO THE FACT THAT THE ANSWERS GIVEN BY ME ARE TRUE & CORRECT TO THE BEST OF MY KNOWLEDGE AND ABILITY. I UNDERSTAND THAT ANY OMISSION (INCLUDING ANY MISSTATEMENT) OF MATERIAL FACT ON THIS APPLICATION OR ON ANY DOCUMENT USED TO SECURE CAN BE GROUNDS FOR REJECTION OF APPLICATION OR, IF I AM EMPLOYED BY THIS COMPANY, TERMS FOR MY IMMEDIATE EXPULSION FROM THE COMPANY.


I UNDERSTAND THAT IF I AM EMPLOYED, MY EMPLOYMENT IS NOT DEFINITE AND CAN BE TERMINATED AT ANY TIME EITHER WITH OR WITHOUT PRIOR NOTICE, AND BY EITHER ME OR THE COMPANY.


I PERMIT THE COMPANY TO EXAMINE MY REFERENCES, RECORD OF EMPLOYMENT, EDUCATION RECORD, AND ANY OTHER INFORMATION I HAVE PROVIDED. I AUTHORIZE THE REFERENCES I HAVE LISTED TO DISCLOSE ANY INFORMATION RELATED TO MY WORK RECORD AND MY PROFESSIONAL EXPERIENCES WITH THEM, WITHOUT GIVING ME PRIOR NOTICE OF SUCH DISCLOSURE. I UNDERSTAND THAT I WILL BE REQUIRED TO UNDERGO A CRIMINAL BACKGROUND CHECK AND DRUG SCREEN.


Applicant's Signature:
Date (YYYY-MM-DD):


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