APPLICATION FOR EMPLOYMENT -


First Name: - Middle Initial: - Last Name:

Address:

City: - State (ex. MN): - Zip:

Home Phone: -- - Cell Phone: --

E-mail Address:

Position Applied For:

Wage Requirements:

Date Available (ex. 05/05/2006): //

What days of the week are you available to work?:

I am able to travel:

Region you'd like to work in (see map):

Are you 18 years of age or older?: Yes - No


Referral Source:

If referred by an employee, Name of employee:

Have you filed an application with UniqueScreen Media before?: Yes - No

Have you been employed with UniqueScreen Media before?: Yes - No

Are you legally authorized to work for any employer in the United States?
(Proof of Citizenship or immigration status will be required upon employment):
Yes - No

Have you been convicted of a felony within the last 7 years?: Yes - No

If so please provide dates and details.
(Responding yes is not an immediate disqualification of employment):

EDUCATION

High School or Prep:

City: - State (ex. MN):

Major, Course or Subjects:

Degree Earned: Yes - No

Business School or College:

Major, Course or Subjects:

Years Completed:

Degree Earned: Yes - No

Graduate School:

City: - State (ex. MN):

Major, Course or Subjects:

Years Completed:

Degree Earned: Yes - No

EMPLOYMENT HISTORY - (Most Recent)

Company Name:

Address:

City: - State (ex. MN): - Zip:

Employment Dates (ex. 05/05/2006): // to //

Starting Wage: - Ending Wage:

Company Phone: --

Job Title:

Job Duties:


Reason for Leaving:


EMPLOYMENT HISTORY - EMPLOYER 2

Company Name:

Address:

City: - State (ex. MN): - Zip:

Employment Dates (ex. 05/05/2006): // to //

Starting Wage: - Ending Wage:

Company Phone: --

Job Title:

Job Duties:


Reason for Leaving:


EMPLOYMENT HISTORY - EMPLOYER 3

Company Name:

Address:

City: - State (ex. MN): - Zip:

Employment Dates (ex. 05/05/2006): // to //

Starting Wage: - Ending Wage:

Company Phone: --

Job Title:

Job Duties:


Reason for Leaving:


PROFESSIONAL REFERENCES

Name: - Company:

Title: - Phone: --


Name: - Company:

Title: - Phone: --


Name: - Company:

Title: - Phone: --


RESUME

Attach PDF or Word file:


Copy and paste your resume below:



The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not intended to be a contract for employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is at-will and can be terminated by either party with or without notice, at any time, for any reason, or no reason. No one other than an officer of the Company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing an then only in writing signed by an officer.

 
I hereby authorize and permit credit companies, police agencies, former employers, schools and references to provide information concerning me to UniqueScreen Media and I expressly release UniqueScreen Media any such information provider from any liability related to the provision of information pertaining to me.

  (You must check here after you've agreed to the above).










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