Application | Save That Stuff

The Company considers all applicants without regard to race/color, national origin, sex, age, disability, genetics, physical or mental handicap, veteran or national guard status, religion, ancestry, genetic information, sexual orientation, pregnancy, or any other category protected by federal, state or local law. Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

If you need assistance in completing this application, please let us know so that we can discuss a reasonable accommodation.

Position(s) applied for

Position(s) Applied For

Date of Application

First Name

Middle Name

Last Name

Address

Current Address

Home Address

City

State

Zip Code

Cell Phone #

Home / Other Phone #

Email Address

Referral Source (Please add the name the sources according on the fields provided)

Walk-In

Internet

Job Fair

Government Employment Agency

Employee

Company's Website

School

Staffing Agency

Other

Are you legally eligible for employment in the US?

Yes

Will you travel if job requires it?

Yes

Have you ever worked for us before?

Yes

Provide the dates below

From

Do you have any relatives employed at the Company?

Yes

Provide some of the names

Will you work overtime if required

Will you work overtime if required?

Yes

Please explain why

Date available for work

What is your desired salary range or hourly rate of pay for this position? (Do not complete if in MA)

EMPLOYMENT HISTORY

Starting with your most recent employer, provide the following information. You may include military service and any verifiable volunteer work.

Current Employer

Telephone #

Street Address

Dates Employed

From

Starting / Final Job Title

Immediate supervisor

May we contact for reference?

Yes

Later

Reason for Leaving

Summarize the top of work performed and job resposibilities

Employer 1

Telephone #

Street Address

Dates Employed

From

Starting / Final Job Title

Immediate supervisor

May we contact for reference?

Yes

Later

Reason for Leaving

Summarize the top of work performed and job resposibilities

Employer 2

Telephone #

Street Address

Dates Employed

From

Starting / Final Job Title

Immediate supervisor

May we contact for reference?

Yes

Later

Reason for Leaving

Summarize the top of work performed and job resposibilities

SKILLS AND QUALIFICATION

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying.

EDUCATIONAL BACKGROUND

Starting with your most recent school attended, provide the following information.

School (include CIty & State)	Years Completed	Completed	GPA Class Rank	Major / Minor

REFERENCES

List name and telephone number of three professional references who are not related to you, preferably direct supervisors. If not applicable, list three school or personal references who are not related to you.

Name	Title	Relationship to you	Telephone Number	Number of Years Known

Integrated Human Resources may run background checks appropriate to the position including, but not limited to, references, criminal, sexual offender, credit, driving, personality, or drug.

Massachusetts Lie Detector Law: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal and civil liability.

APPLICANT STATEMENT

I certify that all information I have provided in order to apply for and secure work with the Company is true, complete and correct.

I expressly authorize, without reservation, the Company, its representatives, employees or agents to conduct a background check and to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby release any individual, agent, and the Company and its agents, servants, and employees, directors, officers and representatives from all claims and liabilities whatever that may arise from disclosure of such information.

I understand that the Company does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. The Company is an at-will employer. At any time and for any reason either you or the Company may terminate employment.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the Company reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice. This application does not constitute an agreement or contract for employment for any specified period of definite duration. I understand that no supervisor or representative of the Company is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the Company’s Executive Director.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws required me to complete an I-9 Form in this regard.

I also understand that for certain positions I may be subject to a CORI check or background check and may be required to undergo drug testing.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant

Date