EBI LLC - Employment Application Form

Personal Information

First Name*

Last Name*

Telephone*

Cell phone

E-mail*

Are you 18 years of age or older?*

Are you legally eligible for employment in the U.S.*

Contact address

Street address*

city*

Zip code*

State*

Employment interest

Department*

Position*

Desired hourly rate*

Date you can start*

Can you work overtime if necessary?*

EDUCATION AND TRAINING

EDUCATION*

Name/City, State

Course of study

No. years completed

Did you graduate ?

Degree/Diploma

Employment history

Company Name

Salary / hourly rate

Start Date

End Date

City / State

Phone number

Job title

Reason for leaving

Questions

Have you ever been convicted of, or plead guilty to a Misdemeanor? *If yes, please explain below.

Yes

Have you ever been convicted of, or plead guilty to a Felony? *If yes, please explain below.

Yes

NOTE: Answering yes for above questions will not necessarily disqualify an applicant from employment. Factors such as age and date of offense, the seriousness of the violation and rehabilitation will be considered. Not answering this question completely and truthfully, if discovered through a criminal background investigation, will result in falsification of application and not being hired and/or terminated if hired.

EBI maintains a drug free environment and requires prospective employee’s to pass a drug test. Are you still interested in working for EBI?*

Will you authorize EBI to conduct a criminal background investigation*

If your Supervisor in your present or most recent job rated your overall performance (productivity, attendance/tardiness, attitude, etc.) what would it be?*

Are you eligible for rehire at all of your previous employers? *

Are any members of your family or other relatives [i.e., a spouse, parent, child, sibling, in-law, aunt, uncle, niece, nephew, cousin, grandparent, grandchild or significant other] or non-family members of your household currently employed at EBI?
*If yes, please list their name(s) below

Yes

Employment application supplement

This information is needed for statistical purposes to meet Federal Affirmative Action reporting requirements on Equal Employment Opportunity. Your participation in this survey is voluntary and your replies will be kept confidential. This survey will be detached from the application form prior to review of your qualifications.

Gender

Age

Ethnic background

A. White, Non-Hispanic
A U.S. citizen having origins in any of the original peoples of Europe, North Africa, or the Middle East.
B. Hispanic
A U.S. citizen of Mexican, Puerto Rican, Cuban, Central or South America or other Spanish cultureor origin, regardless of race.
C. Asian
Includes Chinese, Japanese, Korean, Filipino, Burmese, Thais, Vietnamese, Pacific Islanders, and others from Asia.
D. Black (African-American)
A U.S. citizen having origins in any of the Black racial groups of Africa. Non-Hispanic.
E. American Indian
Includes Alaskan and other Native Americans.
F. OTHER
Check here if you are uncertain of the category to which you belong and enter either: Specific ethnic decent or Mixture of ethnic decent

Did you serve in the U.S. armed forces during the Vietnam Era?

Are you a disabled veteran?

Do you have a disability?

Certificate of applicant

I hereby certify that the facts set forth in this employment application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application may result in disciplinary action up to and including termination.

I hereby authorize all of my present and former employers, school authorities, and persons listed as personal references to furnish EBI, or any agent acting on its behalf, information concerning my personal character, work habits, and employment record (such as a  statement of the reasons for the termination or separation of my employment), work performance, abilities, and other qualities pertinent to my qualifications for employment. I hereby release all such persons and EBI and their respective officers, directors, employees, or agents, in both their individual and representative capacities, from any and all liability for damages of whatever nature arising from furnishing or receiving the requested information.

EBI is hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of EBI’s choice. I also understand that, upon written request, I will be informed if a consumer credit report was requested, and if such a report was requested. I will be told the name and address of the agency furnishing the report.

I understand that I may be required to undergo screenings for substance abuse (drugs) as a condition of employment. I also understand that all my employment with EBI or any affiliate thereof is “at-will” and may be terminated by EBI or by me at any time and for any reason or no reason at all with or without notice.

EBI is an equal opportunity employer. Our policy is to consider all applicants for employment based on their qualifications and our current job vacancies. Applicants are considered without regard to race, color, religion, gender, national origin, age, disability, or marital status or any other category that may be protected under applicable law.

I agree with statement above

Cover Letter

We will appreciate if you submit your cover letter