Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Alternate Phone
(###)
###
####
Present Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Years (round up)
*
Previous Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Years (round up)
Desired Salary / Hourly Rate
*
If under the age of 18, can you produce the necessary work certificate at the time of employment?
Type of Employment Desired?
*
Are you willing to work over time?
Date on which you can start work if hired
*
MM
DD
YYYY
Have you been referred to Up and Out, Inc. for employment:
*
If "Yes", by whom:
Have you previously applied for employment with this company?
*
If yes, when and where did you apply?
Have you ever been employed by this Company?
*
If yes, provide dates of employment, location, and reason for separation from employment.
Have you ever plead guilty or no contest to, or been convicted of any criminal offense other than the applicable exceptions listed above?
*
Have you ever been arrested for any matters for which you are out on bail or on your own recognizance pending trial?
*
CRIMINAL OFFENSES ONLY
If you answered “Yes” to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that individual circumstances can be considered.
Have you ever had a founded report of child abuse or substantiated adult abuse?
*
If Yes, please provide the date(s) and explain so that individual circumstances can be considered.
(A “Yes” answer will not necessarily disqualify you from employment.)
Do you meet the minimum standards?
*
List all special technical skills that you feel qualify you for the job for which you are applying
(e.g. computer Programming/language, software, equipment operation, special tools or machines, etc.)
Is any additional information relative to change of name, use of an assumed name, or nickname necessary to enable a check on your work and educational record?
Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Type of Business
Phone
(###)
###
####
Date Employed FROM:
MM
DD
YYYY
TO:
MM
DD
YYYY
Job Title
Duties
Supervisor's Name
First Name
Last Name
May we contact?
If no, why not?
Reason for Leaving?
What will this employer say was the reason your employment terminated?
How much notice did you give when resigning? If none, explain.
Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Type of Business
Phone
(###)
###
####
Date Employed FROM:
MM
DD
YYYY
TO:
MM
DD
YYYY
Job Title
Duties
Supervisor's Name
First Name
Last Name
May we contact?
If no, why not?
Reason for leaving?
What will this employer say was the reason your employment terminated?
How much notice did you give when resigning? If none, explain.
Please explain fully any gaps in your employment history in excess of one month
Have you ever been terminated or asked to resign from any job?
Has your employment ever been terminated by mutual agreement?
Have you ever been given the choice to resign rather than be terminated?
If you answered Yes to any of the above three questions, please explain the circumstances of each occasion.
Application Certification
I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license and automobile liability insurance in an amount equal to the minimum required by the state where I reside.
I understand that Up and Out, Inc. may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If Up and Out, Inc. is such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn, I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant Up and Out, Inc.’s policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs.
If employed, I understand that the taking of alcohol and/or drugs test is a condition of employment and I agree to undergo alcohol and drug testing consistent with Up and Out, Inc.’s policies and applicable federal, state, and local law.
If employed by the Company, I understand and agree that Up and Out, Inc., to the extent permitted by federal, state and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstance, my personal property.
I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law I may be required to sign confidentiality, non-compete, and/or conflict of interest statement.
I certify that all the information on this application, my resume, or any supporting documents I may present during an interview is and will be complete and accurate to the best of m knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action up to and including immediate dismissal.
I UNDERSTAND THAT NEITHER THIS APPLICATION NOR ANY COMMUNICATION BY AN UP AND OUT, INC. REPRESENTATIVE IS INTENDED TO CREATE OR DOES CREATE A CONTRACT OF EMPLOYMENT, OFFER OR PROMISE OF EMPLOYMENT FOR A DEFINITED TERM. I ACKNOWLEDGE THAT IF HIRED BY UP AND OUT, INC., EMPLOYMENT IS ON AN AT-WILL BASIS IN ACCORDANCE WITH OREGON STATE LAW. THIS MEANS THAT GENERALLY, IN THE ABSENCE OF A CONTRACT OR STATUTE TO THE CONTRARY, OREGON EMPLOYERS MAY DISCHARGE AN EMPLOYEE AT ANY TIME AND FOR ANY REASON, OR FOR NO REASON AT ALL. I AM FREE TO TERMINATE MY EMPLOYMENT WITH THE COMPAN AT ANY TIME FOR AN REASON. THIS AT AT-WILL PROVISION MAY BE MODIFIED OR WAIVED ONLY IN A WRITTEN AGREEMENT SIGNED BY AN AUTHORIZED REPRESENTATIVE OF UP AND OUT, INC. AND ME. I AGREE TO CONFORM TO THE RULES AND REULATIONS OF THE COMPANTY, AND I UNDERSTAND THAT UP AND OUT, INC. HAS COMPLETE DISCRETION TO MODIFY ITS RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL OR ITS ARBITRATION POLICY, IF ANY.
I authorize Up and Out, Inc. or its agents to confirm all statements contained in this application and/or resume as it is related to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite Authorization forms for the background investigation.
I authorize and consent to, without reservation, any party or agency contacted by Up and Out, Inc. to furnish the above mentioned information. I hereby release, discharge and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to Up and Out, Inc. or its duly authorized representatives pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability Up and Out, Inc. and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.
If hired by Up and Out, Inc., I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by Up and Out, Inc., I also understand Up and Out, Inc. employs only individuals who are legally eligible to work in the United States Up and Out, Inc.
THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME YOU MUST REAPPLY.
I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE AND COMPLETE.
Applicant Signature | By typing my name I certify that the information I have entered is correct.
*
Date
MM
DD
YYYY
