FutureNet Security Solutions
PLEASE ANSWER ALL QUESTIONS; DO NOT REFER TO RESUME EVEN IF ATTACHED
Last Name
First Name

Middle
Date Available For Work
Present Address City State Zip
Home Phone Email Address
Are you under 18 yrs. of age?
Type of Position Desired
Salary Desired
Social Security # (Last 4 digits ONLY)
xxx-xx-
Referred to this company by
Have you ever been employed by us?
If yes, when?
Are you presently employed?
May we contact your present employer?
UPON OFFER OF EMPLOYMENT YOU WILL BE REQUIRED TO VERIFY YOUR IDENTITY AND AUTHORIZATION TO WORK IN THE U.S.
AN APPLICANT FOR EMPLOYMENT WITH A SEALED RECORD ON FILE WITH THE COMMISSIONER OF PROBATION MAY ANSWER "NO RECORD" WITH RESPECT TO AN INQUIRY HEREIN RELATIVE TO PRIOR ARRESTS OR CRIMINAL COURT APPEARANCES. IN ADDITION, ANY APPLICANT FOR EMPLOYMENT MAY ANSWER "NO RECORD" WITH RESPECT TO ANY INQUIRY RELATIVE TO PRIOR ARRESTS, COURT APPEARANCES AND ADJUDICATIONS IN ALL CASES OF A DELIQUENCY OR AS A CHILD IN NEED OF SERVICES WHICH DID NOT RESULT IN A COMPLAINT TRANSFERRED TO THE SUPERIOR COURT FOR CRIMINAL PROSECUTION.
In the past five years, have you been convicted of a misdemeanor?
If you answered yes to a misdemeanor, please explain:
Have you ever been convicted of a felony?
If you answered yes to a felony, please include when and explain:
Are you affiliated with any other company that would continue to require work of you?
If another company would continue to require work of you, please explain.
Are you engaged in any personal business enterprise?
If you are engaged in a personal business enterprise, please explain.
In what business, professional, or scientific associations do you hold membership which is directly related to the positon for which you are applying?
What professional licenses do you hold?
Have you ever supervised people?
How many people? Where? For how long?
EDUCATION
SCHOOL NAME & ADDRESS DID YOU GRADUATE? DEGREE/CERTIFICATE EARNED
HIGH SCHOOL:
COLLEGE:
GRADUATE SCHOOL:
POST-GRADUATE SCHOOL:
OTHER:
ACTIVITIES AND ACCOMPLISHMENTS (Exclude organizations that indicate race, color, religion, sex or national origin)
Honors and Professional Memberships
Interests/Hobbies
Publications
EMPLOYMENT HISTORY
IMPORTANT: LIST EMPLOYMENT WHETHER OR NOT IT SEEMS RELEVANT TO THE POSITION APPLIED FOR. IF LAPSES OCCURRED BETWEEN PERIODS OF EMPLOYMENT, GIVE DATES OF, AND REASON FOR UNEMPLOYMENT. YOU MAY CONSIDER ANY VOLUNTEER WORK AS PART OF YOUR EMPLOYMENT HISTORY.
If the space provided below does not give your complete employment history, please upload an additional document. Click Here To Upload File
PRESENT OR LAST EMPLOYER
Employer: Address:
Dates Employed: from to Phone: ( -   Ext. 
Supervisor Name & Title : Department:
Starting Salary: Ending Salary: Your Title:
Reason for Leaving?
May we contact this employer for references?
Describe Your Duties:
NEXT PREVIOUS EMPLOYER
Employer: Address:
Dates Employed: from to Phone: ( -   Ext. 
Supervisor Name & Title : Department:
Starting Salary: Ending Salary: Your Title:
Reason for Leaving?
May we contact this employer for references?
Describe Your Duties:
NEXT PREVIOUS EMPLOYER
Employer: Address:
Dates Employed: from to Phone: ( -   Ext. 
Supervisor Name & Title : Department:
Starting Salary: Ending Salary: Your Title:
Reason for Leaving?
May we contact this employer for references?
Describe Your Duties:
NEXT PREVIOUS EMPLOYER
Employer: Address:
Dates Employed: from to Phone: ( -   Ext. 
Supervisor Name & Title : Department:
Starting Salary: Ending Salary: Your Title:
Reason for Leaving?
May we contact this employer for references?
Describe Your Duties:
U. S. MILITARY HISTORY
Branch of Service
Date Entered
Date Discharged
Military Occupational Specialty
ADDITIONAL APPLICANT INFORMATION
What products or services have you sold?
Has your driver's license ever been suspended?
If yes, why?
Indicate any foreign languages that you speak, read, or write.
APPLICANT AGREEMENT

Please Read The Following Paragraphs Carefully

By checking the box and entering my name below, I certify that I have read, understand and agree to each of the following statements:

(a) To the best of my knowledge, all of the information I have supplied on this application is true, accurate, and complete, and I have not knowingly withheld any information that, if known to the Company, would likely affect my application unfavorably.

(b) If I am hired by the Company and the Company discovers at any time during my employment that any of the statements or answers on this application are false, misleading, or incomplete, my employment with the Company may be terminated immediately.

(c) This employment application will be considered active for ninety (90) days from the date submitted. If I desire to be considered for employment with the Company after that time, I must complete and submit a new application.

(d) If offered employment with the Company, I agree to submit to a post-offer, pre-employment drug and alcohol test prior to beginning work with the Company, and I understand that a positive test will result in the rescission of the job offer. I understand that if I am employed by the Company, I will be required to undergo drug and alcohol testing as required under the Company’s Alcohol and Drug Policy, which may require periodic or random testing.

(e) If I accept employment with the Company, as consideration for my initial and continued employment, I agree to abide by all the Company's policies, rules, and requirements throughout the term of my employment.

(f) I understand that nothing in this application creates a contract of employment between me and the Company. If I am hired by the Company, my employment and compensation are "at will," which means that my employment can be terminated by the Company or me at any time, with or without cause and with or without notice.

(g) Effective upon my acceptance of any offer of employment with the Company, I agree to release to the Company and/or its designated insurers or agents my medical information, including but not limited to files, reports, x-rays, evaluations, and opinions, to the extent such information is consistent with applicable laws and regulations, job-related, and consistent with the Company's legitimate business needs. I acknowledge that this is a general release of my medical information and records and will remain in effect for the duration of my employment with the Company.

(h) If I accept employment with the Company and become personally indebted to the Company, I authorize the Company to withhold from my wages such amounts as are permitted by law to satisfy my indebtedness to the Company.

(i) If I accept employment with the Company, I agree that any cause(s) of action or claim(s) that I may have or bring against the Company, or that the Company may have or bring against me, shall be commenced within the applicable statute of limitations period, within one (1) year of my knowledge of such claim or cause of action, or within one (1) year after my separation from employment, whichever is earlier, as allowed by law.

(j) I hereby grant permission for the Company to conduct a background investigation on me and on any information contained in my application. I acknowledge and agree that the background investigation may include without limitation a search, review, or verification of my Social Security Number, previous employers, Sex Offender Registry, credit report, criminal records/history, occupational/professional licensures, academic credentials, driver’s license and driving record which the Company believes is necessary to determine my qualifications for assuming a job with the Company. I give the Company my permission to contact any former employer, school, college or university, utility company, credit or finance bureau or office, any personal or professional reference, or any other appropriate source or individual for the purpose of gathering any information, personal or otherwise, that such sources may have about my character, general reputation, credit, education, or employment record, and I give my consent to any such source to release to the Company whatever information they have about me. I also unconditionally release all named and unnamed sources from any and all liability that might result from furnishing any information about me.

- BY CHECKING THIS BOX, I CERTIFY THAT I HAVE READ AND AGREE TO THE ABOVE STATEMENTS

APPLICANT'S NAME

TODAY'S DATE
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