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Application for Employment

( required fields marked with an * )

* First Name:
     Full Legal Name Required
Middle Name:
* Last Name:
 
 
* Address:
* City/State/Zip:
How Long:
 
 
Previous Address:
 
City/State/Zip:
How Long:
 
 
* Phone Number:
 (Area code and phone number)
Alternate Phone Number:
 (Area code and phone number)
Email:
* Social Security (FICA) #:
- -  
 
Applicant Number:
Position Desired:
 
Date You Can Start:
/ /  
Salary Desired:
Are You Currently Employed:
May We Contact Your Current Employer:
* Ever been employed by Advanced Data Associates:
* If no, have you ever applied for a position at Advanced Data Associates?

High School Name:
High School Address:
 
High School City/State/Zip:
   
Last Year Attended:
Graduated:
   

College/University Name:

College/University Address:
 
College/University City/State/Zip:
   
Last Year Attended:
Graduated:
Degree:
   

Graduate School Name:

Graduate School Address:
 
Graduate School City/State/Zip:
   
Last Year Attended:
Graduated:
Degree:
   

Trade/Technical Name:

Trade/Technical Address:
 
Trade/Technical City/State/Zip:
   
Last Year Attended:
Graduated:
Degree:
   
* 18 years or older:
If under 18, can you supply proof of age:
* Eligible to work in United States:
 (Proof of US citizenship or immigration status will be required upon hire)
* Worked under previous name:
 
Previous Name (First/Last) & Reason:
* Not including any items of a health or medical nature, do you have any personal commitments during your first 90 days of employment that would interfere with your regular attendance and punctuality?
* Can you perform the essential functions of the position for which you are applying with or without reasonable accommodations?
   
Name of Employer:
Address:
City/State/Zip:
Phone Number:
Dates Employed (From/To):
Job Title:
Starting Salary/Ending Salary:
Type of Business:
 
Supervisor Name/Title:
 
Describe Work Performed:
 
Reason for Leaving:
 
 
Name of Employer:
Address:
City/State/Zip:
Phone Number:
Dates Employed (From/To):
Job Title:
Starting Salary/Ending Salary:
Type of Business:
 
Supervisor Name/Title:
 
Describe Work Performed:
 
Reason for Leaving:
 
 
Name of Employer:
Address:
City/State/Zip:
Phone Number:
Dates Employed (From/To):
Job Title:
Starting Salary/Ending Salary:
Type of Business:
 
Supervisor Name/Title:
 
Describe Work Performed:
 
Reason for Leaving:
 


By clicking "Submit" I agree to the following:

I hereby grant permission for Advanced Data Associates Corporation to conduct a general background investigation. I understand that the Company will also thoroughly investigate my work and personal history to verify all data given on this application, on related papers and in the interview process. I authorize all individuals, schools and firms named herein, except present employer if so noted, to provide any information requested about me, and I release them and indemnify Advanced Data Associates, Inc. from all liability for damage in providing this information.

I certify that all the information that I have provided to Advanced Data Associates, Inc. in this application is true, correct and complete, and acknowledge that any falsification or omission may result in refusal of employment, or, if I have begun work with the Company, termination of employment.

I also understand that any offer of employment that the Company might make to me is contingent upon verification of the information that I have provided, and successful completion of a reference and background check.

I acknowledge that all employment with Advanced Data Associates, Inc. is "at-will", meaning that the employment relationship may be terminated by either myself (if I am hired) or the Company at any time, for any legal reason, and with or without cause of notice.













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