Forminator Application – The Audit Store

Employment Application

The Audit Store, Inc. would like to thank you for your interest! Before you proceed, please take a moment to gather the following information needed to completely fill out this application. Aside from your personal contact information, you will need the following: Educational addresses, Professional accreditation, Previous work addresses and contact information, as well as professional reference contact information.

First Name *

Middle Name *

Last Name *

The Audit Store, Inc. believes in the principles and practice of equal employment opportunity. We take pride in the diversity of our workforce. The Audit Store is an Equal Opportunity Employer and considers all qualified applicants and employees for hire, promotion, training, and all other employee action without regard to race, color, religion, age, national origin, ancestry, sex, sexual orientation, marital status, disability, citizenship, veteran status, or any other protected category under applicable federal, state or local laws. Please read the following statements carefully before you sign and complete this application. The Audit Store, Inc., (The Audit Store), in considering my application for employment, may verify the information set forth on this application and obtain additional information related to my background. I expressly authorize The Audit Store or its agents to check my employment references, personal references, schools, etc., to determine my suitability for employment. I authorize all persons, schools, companies, corporations, and law enforcement agencies to supply any information concerning my background, and I release them from all liability for any damage for providing this information. I have read, understand and agree to this statement. *

I understand that The Audit Store has a commitment to maintain an alcohol/drug-free workplace and requires a drug and controlled substance screening test as part of its selection and hiring process. I understand that my employment is conditioned upon several factors including, but not limited to, the passing of the drug and controlled substances test. I understand that such drug and controlled substance screening will consist of the testing of a urine or saliva sample, or other medically recognized test to detect traceable amounts of drug or controlled substance in my body. If the results of any of the tests are positive, I will be disqualified from consideration for employment and any offer of employment withdrawn. I further understand and agree that if I am employed, I may be required to submit to alcohol and/or drug testing, as a result of an accident/injury or reasonable suspicion, during my employment. I have read, understand and agree to this statement. *

I understand that the employment relationship for which I am applying is an employment-at-will relationship. This means the employment relationship is by mutual consent of The Audit Store and myself, is not for any definite period of time, and may be terminated by either The Audit Store or me at any time, without notice, and for any reason or no reason at all. I further understand that this application and the policies, procedures, and benefits contained in any policy and procedure guide or in any other written material disseminated by or for The Audit Store do not constitute an employment contract between The Audit Store and myself or imply the existence of any contractual or other rights. Such policies, procedures, and benefits contained therein may be changed or terminated from time to time by The Audit Store at its sole discretion. These statements about the at-will nature of employment constitute the complete understanding between the company and its employees regarding this subject. I have read, understand and agree to this statement. *

I certify that the information on this application is correct and true. I understand that any misrepresentations or omission of any information may result in my disqualification from consideration for employment or, if employed, my dismissal. I agree that The Audit Store shall not be liable in any respect if my application is disqualified or my employment terminated because of misrepresentations, omissions, or false statements or answers by me either verbally, in writing, or on this application. I have read, understand and agree to this statement. *

Contact Information

Phone Number (Primary) *

Phone Number (Secondary)

Email Address (Primary) *

Email Address (Secondary)

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

County *

Social Security # *

Personal Information

Are you at least 18 years of age? *YESNO

Are you eligible for employment in the United States? *YESNO

Are you able to perform the essential job functions of the position with, or without, reasonable accommodation? *YESNO

If driving is a job function of the position for which you are applying, you must be at least 21 years of age. Please provide: *Driver's License Number

State

Expiration Date

Position Desired *

Date Available *

Salary Range *

Referred by: *

Name of Referral:

Have you ever applied at this company before? *YESNO

Have you ever been employed by this company before? *YESNO

If so, when? *

Have you been convicted of a crime other than a minor traffic violation in the past 7 years? *YESNO

Have you ever been convicted of a crime involving an act of violence, theft or dishonesty? *YESNO

Have you ever been convicted of a crime or sanctioned for violation of law relating to a Federally or State funded health care program or plan, including but not limited to the filing of a false or fraudulent claim for payment, the making of a prohibited referral, or the prohibited solicitation or receipt of remuneration for the making of a referral? *YESNO

Identify the crime or activity for which you were convicted or sanctioned, the date of the conviction or sanction and the location of the court in which you were convicted, or the identity of the government agency that sanctioned you. Please provide any details you feel relevant. Conviction of a crime will not necessarily bar you from employment but will be considered as part of the overall evaluation of your qualifications.) *

Do you have a current employee contract and/or non-compete with any company? *YESNO

If so, please explain:

Education Information

HIGH SCHOOL -name

COLLEGE -name

OTHER SCHOOL -name

HIGH SCHOOL -location

COLLEGE -location

OTHER SCHOOL -location

HIGH SCHOOL -course of study

COLLEGE -course of study

OTHER SCHOOL -course of study

List any professional license, designations, etc.

List any professional organizations

List any specialized training, audit courses, etc.

Work Experience Information

Please list your work experience, including any periods of unemployment, for the last five years. Begin with your most recent employer; ask for an additional sheet if more space is needed to complete your employment history.

Company 1 - Name *

Company 2 - Name *

Company 3 - Name *

Company 1 - City & State *

Company 2 - City & State *

Company 3 - City & State *

Company 1 -Phone *

Company 2 -Phone *

Company 3 -Phone *

Company 1 - Dates employed *

Company 2 - Dates employed *

Company 3 - Dates employed *

Company 1 - Start & Final Salary *

Company 2 - Start & Final Salary *

Company 3 - Start & Final Salary *

Company 1 - Job Title *

Company 2 - Job Title *

Company 3 - Job Title *

Company 1 - Supervisor *

Company 2 - Supervisor *

Company 3 - Supervisor *

Company 1 - Reason for Leaving *

Company 2 - Reason for Leaving *

Company 3 - Reason for Leaving *

If you are currently employed, may we contact your employer? *YESNO

If you were employed under a maiden or other name, what was the name? *

Professional References

List three persons, not related to you, whom you have known at least one year. These references should have a professional work relationship with you.

Reference 1 - Name *

Reference 2 - Name *

Reference 3 - Name *

Reference 1 - Address *

Reference 2 - Address *

Reference 3 - Address *

Reference 1 -Email *

Reference 2 -Email *

Reference 3 -Email *

Reference 1 -Phone *

Reference 2 -Phone *

Reference 3 -Phone *

Reference 1 - Relationship *

Reference 2 - Relationship *

Reference 3 - Relationship *