HUMAN RESOURCES - EMPLOYMENT APPLICATION

If you are interested in any of the current positions at Ashcom, please complete and submit the application below. This application evaluates prospective employees on the basis of merit, without regard to race, age, color, religion, gender or national origin. Please answer all questions on this form to the best of your ability.

Date: (i.e. XX/XX/XXXX) Name: Social Security Number: Email: Phone: Street Address: City: State: Zip/Country Code: Country: Are you 18 years old or older? Yes No Are you eligible to work in the United States? Yes No Please list any preferred position you are seeking: If you were referred by someone to Ashcom, please indicate: Educational Institution Name of School Years Attended Did you Graduate? Subjects Studied/Degrees Awarded Elementary Yes No High School Yes No College Yes No Graduate School Yes No Vocational School/Other Yes No (Begin with Most Recent Position) Start/End Date Employer Name & Address Salary Position Reason for Leaving From: To: From: To: From: To: From: To: Do you have any physical limitations that might preclude you from performing any work for which you are being considered: Yes No If "yes", please describe: Do you have you any defects in any of the following? Please select all that apply: Hearing Vision Speech Person to notify in emergency: Relationship: Phone: Please provide three references (unrelated) whom you have known for at least 1 year: Name Phone Title/Business Address Years Acquainted Please list the office machines your are familiar with: Typing speed: (wpm) Please select all following skills that you are capable of: Dictation Transcription Multi-Line Phone Management Please list any other training, experience, skills or credentials: PLEASE READ CAREFULLY BEFORE ACCEPTING: I certify that the facts contained in this Application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this Application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above. I further understand and agree that, if employed, my employment is for no definite period and may, regardless of the date of payment of my wages, be terminated at any time, without prior notice. By checking this box, you acknowledge the above statements.