Application for Employment

Personal Information	Position Applying for:
	Are you interested in:	Full-Time	Part-Time
Date://	Social Security #:
Name:
	First	Last	Middle


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	Employment Screening, Background , Asset Searches
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	Contact Us

Present Address:
		Street	City	State	Zip Code
Previous Addresses (for past 5 years)
From:	To:	Street	City	State	Zip Code




Telephone:			Alt. Number:

Are you 18 years of age or older?	Yes	No
Are you either a U.S. Citizen or authorized to work in the U.S.?	Yes	No
What foreign languages do you speak fluently?	Read	Write
Do you have your own automobile?	Yes	No
Do you posses a valid driver's license?	Yes	No
Have you ever been convicted of a felony or misdemeanor ?**	Yes	No
If Yes, Please describe:
When? County: State:
** You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.

Employment Desired:
When can you start?	//	Salary Desired	$
Are you employed now?	Yes No	If so, may we inquire of your present employer?	Yes No
Ever applied to this company before?	Yes No	When?	//
Do you have any restrictions on days or hours you can't work? Explain:

Education	Name/Location of School	# of yrs attended	Grad. Yes/No	Subj Studied	Are you Attending Now?
High School
College					Sched:
Trade, Business or Corresp School					Sched:

General
Subjects of special study or research work:
U.S. Military or Naval Service:	Rank	Present membership in National Guard or reserves

Employment History

Complete the following information based upon your past employment:
List most recent or present job first. Explain fully any time gaps between jobs.

Name of the Company:
Address of Company:
Telephone Number:
Dates:	From: To:
Salary:
Name of Supervisor:
List Position/Responsibilities:
Reason for leaving:

Name of the Company:
Address of Company:
Telephone Number:
Dates:	From: To:
Salary:
Name of Supervisor:
List Position/Responsibilities:
Reason for leaving:

Name of the Company:
Address of Company:
Telephone Number:
Dates:	From: To:
Salary:
Name of Supervisor:
List Position/Responsibilities:
Reason for leaving:

Name of the Company:
Address of Company:
Telephone Number:
Dates:	From: To:
Salary:
Name of Supervisor:
List Position/Responsibilities:
Reason for leaving:

References:

Give the names of three persons not related to you, whom you have known at least three year.

Name	Address	Relationship	Tele Number	Yrs Acquainted

Physical Record
Do you have any physical limitations that preclude you from performing any work which for you are being consired?
If yes, what can be done to accommodate your limitation?
Please Describe:

In case of Emergency notify:

Name:	Address:	Phone:

" I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal."

I authorize the investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, If hired, my employment is for no definite period, and may be terminated at any time without prior notice.

Please add your Initials

We are pleased that you are seeking employment with Iversen & Biondo associates. We would like to tell you a little about our company and our personnel policies. We strive to give our clients the best employees and service in the industry, while providing an employee with an opportunity to excel at their job in a supportive work environment where they feel a sense of pride and loyalty toward their company. We are an equal opportunity employer and we ensure equal employment opportunities for all.

When a position is available, we follow several steps in our hiring process. Each step must be completed before an applicant can be employed:
1- Application for employment and background release is completed and signed.
2.- Interviews are conducted.
3.- Background is checked and verified (employment, education, references, criminal, credit, motor vehicles and natbu search).
4.- Substance abuse screening is performed
5. - Right to work in the United States is verified.

Please be sure that your application is complete and initiated so that you may be considered for employment.

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Forest Hills Tower - 118-35 Queens Blvd.
Forest Hills, NY 11375
Tel: (718) 544-9595 - (888) 869-8444
Fax:(718) 544-7626