Application For Employment
 

Politi­_Calls Inc. & Companies is an Equal Opportunity Educational Institution and EEO/Affirmative Action Employer committed to excellence through diversity.  Employment offers are made on the basis of qualifications, and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.

Complete the entire application.  You may attach a resume, but you must still complete all questions; or your application will be deemed incomplete and may not be considered.  Please fill out each box (don't just indicate “See Resume.”) 
 
 
LOCATION
  DATE OF APPLICATION  
 
*
   11/17/17  
 
 
  PERSONAL  

Position Applying For:

*    
 
  Last Name First Name Email  
 

*

* *  

Other names under which you have attended school or been employed:

 
  Address City State/Zip  
  * * *  
  Home Telephone Number: Work Phone: Other Phone:  
  *  
 
       
     

       
Are you eligible to work in the United States?  
*  
Are you 18 years of age or older? If No, what is your current age?
*
Have you ever worked for Politi_Calls? If YES, dates of employment & reason for leaving:
*
Are you related to any current Politi_Calls employee? If YES, their name & their relationship to you?
*
   
How did you learn about this employment opportunity at Politi-Calls ?    
       
Learn about us:    
       
EDUCATION      
High school name
School
Name & Location
Did you graduate?
If No, # of Years left to graduate
If Yes, date of Graduation
Degree received
Major
High School
GED:
College
       
SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position.  Include relevant computer systems and  software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)
       
WORK EXPERIENCE: Please detail your entire work history.  Begin with your current or most recent employer.  If you held multiple positions with the same organization, detail each position separately.  Attach additional sheets if necessary.  Omission of prior employment may be considered falsification of information. Please explain any gaps in employment.  Include full-time military or volunteer commitments.  PLEASE DO NOT complete this information with the notation “See Resume.”   
PLEASE NOTE:  Politi­_Calls Inc. & Companies  reserves the right to contact all current and former employers for reference     information.
       
Dates Employed
(Most recent position)

Shift
Title:
From:
To:


If part-time, #hrs/wk
       
 
Starting Salary:

Ending Salary:

Organization Name:
Organization Address

 Primary duties:

  Reason for Leaving:
 
Dates Employed
(Most recent position)

Shift
Title:
From:
To:


If part-time, #hrs/wk
       
 
Starting Salary:

Ending Salary:

Organization Name:
Organization Address

 Primary duties:

  Reason for Leaving:
 
WORK OPPORTUNITY TAX QUESTIONS:
This company participates in various federal tax credit programs. The information you give will be used to determine the company’s eligibility for these programs and will in no way negatively impact any hiring, retention, or promotion decisions.
Have you received a conditional certification from the state workforce agency (SWA) or a participating local agency for the work opportunity credit?
Are you a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) (food stamps) for any 9 months during the last 18 months?
Are you a veteran and a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps) for at least a 3-month period within the last 15 months?

Are you at least age 18 but not age 40 or older and a member of a family that: a) received Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps) for the last 6 months, or b) received SNAP benefits for at least 3 of the last 5 months, but is no longer eligible to receive them?
Did you receive supplemental security income (SSI) benefits for any month ending during the past 60 days?
Were you referred here by a rehabilitation agency approved by the state, an employment network under the Ticket to Work program, or the Department of Veterans Affairs?
Are you a member of a family that received Temporary Assistance for Needy Families (TANF) payments for at least the last 18 months? (food stamps or general assistance)
Are you a member of a family that received TANF payments for any 18 months beginning after August 5, 1997 (whether or not consecutive months), where the earliest such 18-month period ended within the last 2 years?
Are you a member of a family that stopped being eligible for TANF payments within the last 2 years because federal or state law limited the maximum time those payments could be made?
Did you live in the area impacted by Hurricane Katrina on August 28, 2005?

Are you a veteran that was discharged or released from active duty in the U.S. Armed Forces during the past 5 years and, for at least 4 weeks during the past year, received unemployment compensation?

Are you a veteran entitled to compensation for a service-connected disability and, during the past year, discharged or released from active duty in the U.S. Armed Forces, or, Unemployed for a period or periods totaling at least 6 months?

Are you at least age 16 but not age 25 or older, and a) During the past 6 months, have not attended a secondary, technical, or post-secondary school for more than an average of 10 hours per week, not counting periods during which the school was closed for scheduled vacations, and b) During the past 6 months, if employed, during each consecutive 3-month period within the past 6 months, earned less than you would have earned if you had worked for the applicable minimum wage 30 hours every week during the 3-month period, and c) You do not have a certificate of graduation from a secondary school or a General Education Development (GED) certificate or have a certificate that was awarded at least 6 months ago and have not held a job (other than occasionally) or been admitted to a technical or post-secondary school since you received the certificate.

Were you convicted of a felony or released from a correctional facility for a felony offense in the past year?

 

       

  PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
  I certify that the information on this application and its supporting documents is accurate and complete.  I understand and agree that failure to fully
 complete the form, or misrepresentation or omission of facts,  represents grounds for elimination from consideration for employment, or termination after
 employment if discovered at a later date.  I authorize Politi_Calls Inc.& Companies to investigate, without liability, all statements contained in this
 application and supporting materials.  I authorize references and former employers, without liability, to make full response to any inquiries in connection
 with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening
 for illegal substances upon conditional offer of employment.  I understand that this document is NOT an offer of employment, and that an offer of
 employment, if tendered, does NOT constitute a contract for continued guaranteed employment.  I understand that staff employees of Politi_Calls Inc.& Companies
 serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law.
 If employed, I will be required to furnish proof of eligibility to work in the United States, to file a State security questionnaire and State loyalty oath, and to
 comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would
 be ineligible for benefits including paid time off.  If employed on a regular, benefits-eligible basis, I understand that I would be required to make mandatory
 contributions to the Politi_Calls Inc.& Companies Retirement System or to an optional retirement program, if applicable.  I understand that any benefits I receive may be
 subject to change or discontinuation at any time without prior notice.  I understand that the first SIX MONTHS of regular employment represent a
 provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be  terminated without right of appeal.

       
By checking here you are stating you have read the disclosure.
By checking this box you are consenting to signing the application electronically and agreeing that all the information is true and correct.