Employment Application Back to Employment

An Equal Opportunity Employer | Please complete all fields of the application form.

First Name: Last Name:
Present Address: Address 2:
City: State: Zip Code:
Email:
Home Phone: Cell Phone:

Employment Desired

Position: Salary desired:
Today date: Date can start:

Personal Information

Have you ever applied to or worked for Computer Market Research before? Yes No
If Yes, when?
Do you have any friends or relatives working for Computer Market Research? Yes No
If yes, state name(s) and relationship:
Name: Relationship:
Name: Relationship:
How were you referred for work at Computer Market Research?
Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age). Yes No
If hired, can you present evidence of our U.S. citizenship or proof of your legal right to live and work in this country? Yes No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? Yes No
If no, describe the functions that cannot be performed and/or any accommodation required.
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana-related offenses that are more than two years old, or convictions that have been sealed, expunged, or eradicated, need not be listed.) Yes No
If yes, state nature of the crimes(s), when and where convicted and disposition of the case. (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Education, Training and Experience

High School: Years Attended:
Address:
City: State: Zip Code:
Did you Graduate? Yes No Degree or Diploma:
College/University: Years Attended:
Address:
City: State: Zip Code:
Did you Graduate? Yes No Degree or Diploma:
Vocational/Business: Years Attended:
Address:
City: State: Zip Code:
Did you Graduate? Yes No Degree or Diploma:

Employment History (List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.)

1

Employer Name: Phone:
Type of Business: Supervisor Name:
Address:  
City: State: Zip Code:
Employment Dates: From To Monthly Pay: Starting   Ending
Your Position and Duties:
Reason for Leaving:
May we contact this employer for a reference?       Yes No

2

Employer Name: Phone:
Type of Business: Supervisor Name:
Address:
City: State: Zip Code:
Employment Dates: From To Monthly Pay: Starting   Ending
Your Position and Duties:
Reason for Leaving:
May we contact this employer for a reference?       Yes No

3

Your Position and Duties:
Employer Name: Phone:
Type of Business: Supervisor Name:
Address:
City: State: Zip Code:
Employment Dates: From To Monthly Pay: Starting   Ending
Reason for Leaving:
May we contact this employer for a reference?       Yes No

Please Read Carefully The Agreement Below Before Submit The Form.

  • I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discover.
  • I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
  • I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and Computer Market Research. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company's designated representative.

By submitting the application button below, you have read and agree to the terms outlined above and you have answered the application questions truthfully and to the best of your ability.

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