Sommerhauser Reporting Services Employment Application

*PERSONAL INFORMATION*
Referred by	Job Position you are applying for

* Telephone # Residence
Cell No.
E-Mail
* First Name	M.I.		* Last Name
Do You have reliable transportation?	Do you possess a valid driver's license?

Present Address:
* Street No.	* City
* State	* Zip Code
Previous Address:
Street and No.	City
State	Zip Code

Permanent Address:
Street and No.	City
State	Zip Code

*EMPLOYMENT DESIRED*
Date you will be available for work?
Are you currently employed?
If so, may we contact your employer?
If you have applied to this company before, please indicate when and position.
Do you have any relatives employed by this company?
If so, please list names
If you have worked for this company before, please indicate when and position held.
* Do you seek full or part time employment?
List other names or aliases you have used
* If employed, can you provide proof of legal right to work in the United States.
If no, please explain.
* Have you ever been convicted of a felony or are you on bail pending trial for a felony?
If yes, please explain in full with description of the case.
Skills, abilities, qualifications or experiences which you feel would assist you in this position:
* Do you have or anticipate any obligations which could conflict with a standard work schedule or performance of assigned duties.
If yes, describe.

*EDUCATION HISTORY*
Languages Spoken:

Highest School Grade Completed:

Name City State Grade Completed

Interest

Highest College or University Level Completed:
Name City State Year Completed
Major			Minor

Graduate School Attentded:
Name City State Year Completed
Major			Minor

Trade School Attended:
Name City State Year Completed
Major			Minor
Adult Education or Special Training:

*PROFESSIONAL REFERENCES*
Please list three professional references you have known for at least one year:

1. Name
Address		Telephone
Relationship		Years Known

2. Name
Address		Telephone
Relationship		Years Known

3. Name
Address		Telephone
Relationship		Years Known

In case of emergency, whom should we notify?
* Name
Address
City	State			Zip Code
* Telephone	* Relationship

*EMPLOYMENT HISTORY*

List your present or last position.
* Company Name	Address
* Phone	Name/Title of Supervisor
* Job Title	* Ending Pay
* Dates of Employment (Month/Year) from * to
* Type of work performed
* Reason for Leaving


List your previous position.
Company Name	Address
Phone	Name/Title of Supervisor
Job Title	Ending Pay
Dates of Employment (Month/Year) from to
Type of work performed
Reason for Leaving


List your previous position.
Company Name	Address
Phone	Name/Title of Supervisor
Job Title	Ending Pay
Dates of Employment (Month/Year) from to
Type of work performed
Reason for Leaving


Please explain any gap in Employment History above
Please explain any work related accomplishments you are especially proud of
Hobbies, recreation, Special Interests:
Have you ever been granted a security clearance?
If yes, Date Level
Today's Date:


*READ STATEMENTS BELOW CAREFULLY BEFORE AGREEING*
I certify that the answers given herein are true and complete to the best of my knowledge. I agree that any misrepresentation, false statement, or omission made by me with respect to the information contained in this application or interview(s) shall be sufficient cause to disqualify me from consideration, or if hired, to terminate my employment.
I agree to have any of the statements herein as well as my background investigated by Sommerhauser Reporting Services, Inc., or its agents. I understand that the background investigation may include, but is not limited to, reviewing my education, employment history, credit history, any public records, and personal references. In consideration for reviewing my application and other related information, I hereby waive and release Sommerhauser Reporting Services, Inc., its employees and agents, and all other entities and persons, and their respective employees and agents, from any claims I might have, including defamation and invasion of privacy, arising out of any verbal or written inquiries and/or any verbal or written responses related to investigation of my background as well as the use or disclosure of such information.
I acknowledge and agree that in order to enable the Company to determine whether I possess the skills and other personal qualities necessary to qualify for the position I am applying for, the Company may engage in a testing and interview process which includes reading a full job description. The tests may include but not be limited to those that measure intelligence, aptitude and personality traits required to meet the requirements of the position, including but not limited to meeting the Company's standards for performance, interpersonal relations and competence on the job. Accordingly, I hereby release the Company and any and all Company officers, stock holders, employees, representatives, agents, licensees, licensors, subsidiaries, parent corporations associated with testing services and any and all other related individuals, corporations, partnerships and organization from any and all claims, demands, suits and/or liabilities -- including but not limited to claims based on any state or federal rights of privacy -- arising from or in any way related to such testing and interview processes.
I understand that nothing contained in this pre-employment application or in the granting of an interview is intended to create an employment agreement. I also understand that the completion of this pre-employment application does not indicate there are open positions and does not obligate Sommerhauser Reporting Services, Inc., in any way.
I agree that if employed, I will abide by all policies and procedures established by Sommerhauser Reporting Services, Inc. I understand that my employment is "at will" that I may resign at any time, that Sommerhauser Reporting Services, Inc., may terminate my employment at any time, with or without cause, and that no employee or other representative of Sommerhauser Reporting Services, Inc., has the authority to make an agreement contrary to the foregoing unless it is in writing AND signed by the CEO of Sommerhauser Reporting Services, Inc. This constitutes my entire agreement with Sommerhauser Reporting Services, Inc., with regard to the matters set forth in this paragraph.
I further recognize that employment is subject to:
* Receiving satisfactory reports from all references solicited. * Approval of the management of Sommerhauser Reporting Services, Inc., in which employment may be offered.
I also recognize that I will be required to:
* Supply a record of birth, U.S. citizenship, or visa status, as appropriate * Sign statements dealing with our policy on Conflict of Interest, Confidential Information, Drugs, Harassment, and certain other employment forms.
It is understood that if, after I have submitted this application to Sommerhauser Reporting Services, Inc., any changes occur which affect the accuracy of the information entered herein, it shall be my responsibility to inform Sommerhauser Reporting Services, Inc., of such changes prior to accepting employment. Thank you for expressing an interest in working for our company.
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