Employment Application

PLEASE READ BEFORE FILLING OUT THIS APPLICATION: This company does not discriminate in hiring or employment on the basis of any categories protected by State or Federal law. No question on this application is intended to secure information to be used for such discrimination. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

== GENERAL ======
First Name *
Middle Name
Last Name *
Street Address
City
State
Zip Code
Length of time at above address (years & months)
If less than 1 year at above address, list other U.S. address
Do you have a valid WISCONSIN Drivers License	Yes No Other State
If valid license in Other State, which state?
Home Phone *
Cell Phone
Work Phone
Email *
Are you at least 18 years old?	Yes No
*Have you ever been convicted of any offense (other than a minor traffic violation)?	Yes No
*If yes, identify the type of conviction, date, sentence, and county in which imposed
*List any pending charges against you
*This information may not automatically disqualify you from consideration.
== AVAILABILITY ======
Preferred status	Full Time Part Time
If Part Time, what hours/days?
Select availability	Overtime Saturday Sunday
Indicate any hours you cannot work
Date available for work
Type of work desired
== EDUCATION ======
High school name & address
Completed high school	Yes No
Technical school name & address
Major course or subject
Grade level completed	1 2 3 4
College name & address
Major course or subject
Grade level completed	1 2 3 4
Graduate school name & address
Major course or subject
Grade level completed	1 2 3 4
Other information (e.g., scholastic honors, offices held in educational/civic organizations, seminars, workplce training, skills)
== EMPLOYMENT RECORD ======
Starting with PRESENT or MOST RECENT, list all previous employers. Include self-employment, summer and part-time jobs.
EMPLOYER 1 name & address
Employer 1 start date
Employer 1 end date
Employer 1 starting salary
Employer 1 ending salary
Employer 1 title, position, duties
Employer 1 reason for leaving
EMPLOYER 2 name & address
Employer 2 start date
Employer 2 end date
Employer 2 starting salary
Employer 2 ending salary
Employer 2 title, position, duties
Employer 2 reason for leaving
EMPLOYER 3 name & address
Employer 3 start date
Employer 3 end date
Employer 3 starting salary
Employer 3 ending salary
Employer 3 title, position, duties
Employer 3 reason for leaving
If you are now employed, may we contact your present employer?	Yes No
Attach your resume
== PROFESSIONAL REFERENCES ======
Please do not list relatives or personal friends who cannot refer to your professional abilities.
REFERENCE 1 Name, occupation, address, phone
Number of years Reference 1 has known you
REFERENCE 2 Name, occupation, address, phone
Number of years Reference 2 has known you
REFERENCE 3 Name, occupation, address, phone
Number of years Reference 3 has known you
== AUTHORIZATION & SIGNATURE ======
I understand that references will be contacted, and that appropriate work-related references are not limited to those listed in my application.	Agree
I authorize Visonex to contact/secure info about my education, work experience, credit rating, licensing or any governmental agency, and any other info source relevant to employability.	Agree
I hereby release Visonex, its subsidiaries, officers, and agents from liability for seeking such info, and all other persons, schools, or organizations for providing info.	Agree
In processing this employment application, we may request that an investigative consumer report be prepared, which may include information as to your employment, finances, and general reputation. You have the right to request that we completely and accurately disclose to you the nature and scope of the investigation requested. Such a request must be made in writing to this company within a reasonable time after you complete this application.
/s/ electronically signed by (type your name)
Signature date