Employment Application

Position Title * :
Position Type * : Part Time Full Time
First Name * :
Middle Name :
Last Name * :
Social Security Number * : (9 Digits)
Address * :
City / State / Zip Code * : / /
Phone Number * : (10 Digits)
Alternate Phone Number : (10 Digits)
Date of Birth * : (mm/dd/yyyy)
E-mail Address :

Availability

Days * : Mon Tues Wed Thur Fri Sat Sun
Hours * : 8 a.m. - 5 p.m. 6 p.m. - 11 p.m.
Do you have any relatives working for VIS? *
If yes, please list relatives
Desired Hourly Pay Rate :

Education

Name of High School : / Graduated
City / State of High School : /
Highest Grade Completed :
College or Technical School :
City / State : /
Degree Received :
Have you ever been convicted of a felony?
If yes, please list charge and date:

Employment

Current Employer

Company Name :
Supervisor Name :
Phone Number : (10 Digits)
Position Held :
Duties
Reason for Leaving
Employment Date : From - To (mm/dd/yyyy)
Salary : Beginning - Ending

Previous Employer

Supervisor Name :
Phone Number : (10 Digits)
Position Held :
Duties
Reason for Leaving
Employment Date : From - To (mm/dd/yyyy)
Salary : Beginning - Ending

References

Name (Work) * :
Address :
City / State / Zip Code * : / /
Phone * : (10 Digits)
 
Name (Work) * :
Address :
City / State / Zip Code * : / /
Phone * : (10 Digits)
 
Name (Personal) * :
Address :
City / State / Zip Code * : / /
Phone * : (10 Digits)
 

Essential physical functions of this position requires continuous standing, walking, climbing, bending, crouching, push/pulling, carrying, reaching overhead and lifting/lowering of weight from 1 - 100 pounds. There will be physical exposure to cold, heat, dampness and noise. Good hearing, color discrimination and depth perception are necessary. The ability to work appropriately with other in close proximity is a must.

Disclosure of criminal record will not automatically bring an employment disqualification with VIS Management. Each conviction will be evaluated on its own merits with respect to time, circumstances and seriousness of the applied job. However, failure to disclose all required information may result in disqualification on the employment application with VIS Management.

I certify that the above answers are true and honestly recorded, and it is further understood that false statements will be grounds for intermediate termination.

Application will be retained for 1 year.

VIS is an equal opportunity employer, we do not discriminate based on color, religion, age, or sex

* I hereby authorize VIS Management Solutions to conduct an appropriate background investigation including, but not limited to, personal interviews for determination of my eligibility to occupy a position of trust. I authorize all person who may have information relevant to this background investigation to disclose it to VIS Management Solutions or any agency on behalf of VIS Management Solutions, and I release all persons from liability on account of such disclosure. This release is effective prior to and at any time during, my employment with VIS Management Solutions.

I hereby further authorize that for purposes necessary by VIS Management Solutions a photocopy of this information may be considered as valid as an original.

* required fields