Employment Application

NIECE EQUIPMENT/ NIEMCO/ NIECE PRODUCTS OF KANSAS
Employment Application / Solicitante de Empleo
APPLICANT INFORMATION/ INFORMATION DEL SOLICITANTE
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Last Name/ Apellido(s)
First Name/ Nombre
M.I.
Date/ Fecha
Street Address/ Dirección
City/ Ciudad
(
Apartment/ Unit#/ Número
State/ Estad
Zip/ Código Postal
)
Phone/ Teléfono
Email Address/ Dirección de correo electrónico
Date Available/ Fecha Disponible
Social Security No./ Número de la seguridad social
$
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Desired Salary/ Salario Deseado
PosiHon Applied for/ Posición que solicita
Are you a ciHzen of the United States?
(¿Es usted un cuidadano de Los Estados Unitos?)
□ Yes □ No
If so, when?_______________ ______________________
(Si)
(Si es asi, ¿Cuando?)
If no, are you authorized to work in the U.S.? □ Yes □ No
Have you ever been convicted of a felony?
(¿Si no, estás autorizado para trabajar in el U.S.?)
(¿Alguna vez ha sido condenado por un delito grave?)
Have you ever worked for this company?
(¿Alguna vez ha trabajado para esta compañia?)
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(Si)
□ Yes □ No
□ Yes □ No
(Si)
If yes, explain?_____________ ______________________
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(Si)
(In caso afirmaPvo, explique)
EDUCATION/ EDUCACIÓN
High School ___________________________________
Address _____________________________________________
(Escuela Primaria)
(Dirección)
From ____________
To ______________
Did you graduate?
(Desde)
(Hasta)
(¿Te graduaste?)
College ___________________________________
□ Yes □ No
Degree _________________
(Grado)
Address _____________________________________________
(Colegio)
(Dirección)
From ____________
To ______________
Did you graduate?
(Desde)
(Hasta)
(¿Te graduaste?)
Other ___________________________________
□ Yes □ No
Degree _________________
(Grado)
Address _____________________________________________
(Otro)
(Dirección)
From ____________
To ______________
Did you graduate?
(Desde)
(Hasta)
(¿Te graduaste?)
□ Yes □ No
Degree _________________
(Grado)
REFERENCES/ REFERENCIAS
Please list three professional references
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(Por favor, enumere tres referencias profesionales)
Full Name __________________________________________ RelaHonship _________________________________________
(Nombre Completo)
(Relación)
Company__________________________________________
Phone number _______________________________________
(Empresa)
(Teléfono)
Address _________________________________________________________________________________________________
(Dirección)
Full Name __________________________________________ RelaHonship _________________________________________
(Nombre Completo)
(Relación)
Company__________________________________________
Phone number _______________________________________
(Empresa)
(Teléfono)
Address _________________________________________________________________________________________________
(Dirección)
Full Name __________________________________________ RelaHonship _________________________________________
(Nombre Completo)
(Relación)
NIECE EQUIPMENT/ NIEMCO/ NIECE PRODUCTS OF KANSAS
Employment Application / Solicitante de Empleo
Company__________________________________________
Phone number _______________________________________
(Empresa)
(Teléfono)
Address _________________________________________________________________________________________________
(Dirección)
PREVIOUS EMPLOYMENT/ EMPLEO ANTERIOR
Company __________________________________________
Phone Number _(______)_______________________________
(Empresa)
(Teléfono)
Address____________________________________________ Supervisor ___________________________________________
(Dirección)
Job Title ____________________________________ StarHng Salary $______________ Ending Salary $___________________
(Titulo de Empleo)
(Sueldo Inicial)
(Terminando Salario)
ResposibiliHes ____________________________________________________________________________________________
(Responsibilidades)
From ____________
To ______________
Reason for leaving ____________________________________________
(Desde)
(Hasta)
(Razón de irse)
May we contact your previous supervisor for a reference?
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□ Yes
(¿Podemos ponernos en contacto con su supervisor para una referencia?)
□ No
(Si)
Company __________________________________________
Phone Number _(______)_______________________________
(Empresa)
(Teléfono)
Address____________________________________________ Supervisor ___________________________________________
(Dirección)
Job Title ____________________________________ StarHng Salary $______________ Ending Salary $___________________
(Titulo de Empleo)
(Sueldo Inicial)
(Terminando Salario)
ResposibiliHes ____________________________________________________________________________________________
(Responsibilidades)
From ____________
To ______________
Reason for leaving ____________________________________________
(Desde)
(Hasta)
(Razón de irse)
May we contact your previous supervisor for a reference?
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□ Yes
(¿Podemos ponernos en contacto con su supervisor para una referencia?)
□ No
(Si)
Company __________________________________________
Phone Number _(______)_______________________________
(Empresa)
(Teléfono)
Address____________________________________________ Supervisor ___________________________________________
(Dirección)
Job Title ____________________________________ StarHng Salary $______________ Ending Salary $___________________
(Titulo de Empleo)
(Sueldo Inicial)
(Terminando Salario)
ResposibiliHes ____________________________________________________________________________________________
(Responsibilidades)
From ____________
To ______________
Reason for leaving ____________________________________________
(Desde)
(Hasta)
(Razón de irse)
May we contact your previous supervisor for a reference?
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□ Yes
(¿Podemos ponernos en contacto con su supervisor para una referencia?)
□ No
(Si)
MILITARY SERVICE/ SERVICIO MILITAR
Branch __________________________________________
From ____________
To ______________
(Sucursal)
(Desde)
(Hasta)
Rank at Discharge_________________________________
Type of Discharge _____________________________________
(Posición en el alta)
(Tipo de descarga)
If other than honorable, explain ______________________________________________________________________________
(Si no honorable, explicar)
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DISCLAIMER & SIGNATURE/ DESCARGO DE RESPONSABILIDAD Y FIRMA
I cerHfy that my answers are true and complete to the best of my knowledge.
If this applicaHon leads to employment, I understand that false or misleading informaHon in my applicaHon or interview may
result in my release.
CerHfico que mis respuestas son verdaderas y completas a lo mejor de mi conocimiento.
Si esta aplicación conduce al empleo, enHendo que cualquier información falsa o engañosa en mi solicitud o entrevista puede resultar en mi liberación.
NIECE EQUIPMENT/ NIEMCO/ NIECE PRODUCTS OF KANSAS
Employment Application / Solicitante de Empleo
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Signature ________________________________________________
Date ___________________________
(Firma)
(Fecha)
Print Name ________________________________________________
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(Imprimir Nombre)
AUTHORIZATION AND RELEASE TO OBTAIN INFORMATION
Under the provisions of the Fair Credit ReporHng Act, 15 USC, SecHon 1681 et seq., the Americans with DisabiliHes
Act and all applicable federal, state, and local laws, I hereby authorize and permit Niece Equipment/ NIEMCO/
Niece Products of Kansas (hereacer “NIECE”) to obtain a consumer report and/or an invesHgaHve consumer report
which may include the following:
1.
My employment records.
2.
Records concerning any driving, criminal history, credit history, civil record, workers’ compensaHon and
drug tesHng.
3.
(For company vehicle drivers only) in accordance with the Department of TransportaHon Motor Carrier
Safety RegulaHons, SecHon 382.413, informaHon concerning alcohol and controlled substances for the
past 2 years.
4.
VerificaHon of my academic and/or professional credenHals, and informaHon and/or copies of documents
from any military service records.
I understand that and “invesHgaHve consumer report” may include informaHon as to my character, general
reputaHon, personal characterisHcs, and mode of living which may be obtained by interviews with individuals with
whom I am acquainted or who may have knowledge concerning any such items of informaHon.
I agree that a copy of this authorizaHon has the same effect as an original.
I hereby release and hold harmless any person, firm, or enHty that discloses mamers in accordance with this
authorizaHon, as well as NIECE from liability that might otherwise result from the request for use of and/or
disclosure of any and all of the foregoing informaHon.
I understand and acknowledge the under provision of the Fair Credit ReporHng Act I may request a copy of any
consumer report from the consumer reporHng agency that compiled the report, acer I have provided proper
idenHficaHon.
I hereby authorize NIECE to obtain and prepare an invesHgaHve consumer report as set forth above, as part of its
invesHgaHon of my employment applicaHon. This authorizaHon shall remain in effect over the course of my
employment. Reports may be ordered periodically during the course of my employment.
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Full Name
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_____________________________________
(Please print clearly) Name
Signature
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_______________________________________
DOB
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_______________________________________
Social Security Number
_____________________________________
Driver’s License Number
_____________________________________
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NIECE EQUIPMENT/ NIEMCO/ NIECE PRODUCTS OF KANSAS
Employment Application / Solicitante de Empleo
_______________________________________
Date
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DISCLOSURE
As part of our hiring background and invesHgaHon, we may obtain consumer reports to prepare an invesHgaHve consumer report. The
invesHgaHve consumer report may consist of contacHng all listed prior employers to verify your employment history. It may also include, but
not be limited to, credit informaHon reports, criminal history reports, and driving history records. Under the provisions of the Fair Credit
ReporHng Act (15 USC at 1681 – 1681u) as amended, before we can seek such reports, we must have your wrimen permission to obtain the
informaHon. You have the right, upon wrimen request, to a complete and accurate disclosure of the nature and scope of the invesHgaHon. You
are also enHtled to a copy of your Rights Under the Fair Credit ReporHng Act.