APPLICATION FOR EMPLOYMENT
 
Televerde is an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis including race, color, religion, sex, national origin, sexual orientation, age, disability, status as a Vietnam-era or special disabled veteran, or any other legally protected status. Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in the application process.
 
*required
PERSONAL INFORMATION
   
*First Name
Middle Name
*Last Name
*Street Address
*City
*State
*Zip
*Phone
Referred by
How did you hear about Televerde?
*Email
18 years of age or older
   
EMPLOYMENT DESIRED
   
*Position (essential to complete)
Date Available
Salary Desired
Are you employed now?
May we contact your present employer?
Have you applied at Televerde before?
Can you provide documents which establish your right to work in the United States?
If not, do you have a work permit or alien registration card which allows you to legally work in the United States? Note: Documents which establish work authorization and identity will be required prior to employment.
Have you ever been convicted of a felony?
Are you restricted as to what days of work or hours per day you can work?
If yes, please describe your restrictions:
   
EDUCATION
   
High School Number of years
attended		 Graduated Subjects studied Grade average
Name
Location

 

 
College or University Number of years
attended		 Graduated Type of degree Grade average
Name
Location

 

 
Business or Trade School Number of years
attended		 Graduated Subjects studied Grade average
Name
Location
   
GENERAL
   
Job Related Skills (typing, licenses, etc.)
Subjects of special study or research work
List Certifications
   
EMPLOYMENT HISTORY
 
Please list all full-time and part-time jobs, giving last job first.  Please include all military service.
 
Name of Company
Address
City
State
Zip
Job held
Supervisor
Phone
Date started
Date left
Rate of pay
Reason for leaving
May we contact your current employer?
May we contact you at your current place of employment?

 

 
Name of Company
Address
City
State
Zip
Job held
Supervisor
Phone
Date started
Date left
Rate of pay
Reason for leaving
May we contact this employer?

 

 
Name of Company
Address
City
State
Zip
Job held
Supervisor
Phone
Date started
Date left
Rate of pay
Reason for leaving
May we contact this employer?
   
PLEASE READ CAREFULLY
 

Televerde adheres to a policy of non-discrimination with respect to race, color, religion, sex, national origin, sexual orientation, age, disability, status as a Vietnam-era or special disabled veteran, or any other legally protected status. The Age Discrimination in Employment Act of 1967 as amended prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.

A routine inquiry may be made during the processing of this application that will provide information concerning your employment record and/or education. Information as to the nature and scope of this inquiry will be provided upon written request.

Applicants accepted for employment are hereby notified that employment and compensation can be terminated, with or without cause or notice, at any time at the option of either Televerde or employee.

Applicant agrees that all information printed here has been read and understood and that the information provided by the undersigned is true and complete and that any misinterpretation, falsification or willful omission may be sufficient reason for refusal of employment or dismissal after employment. In addition, applicant acknowledges that employment references may be contacted to verify previous employment.
 
AFFIRMATIVE ACTION
 

VOLUNTARY APPLICANT SELF-IDENTIFICATION SURVEY

To comply with applicable federal, state and local regulations and laws, Televerde is required to keep records and perform statistical analysis of our applicant pool by race, ethnicity and gender. Because analysis in only possible if we know the EEO profile of our applicants, we are asking you to complete this voluntary survey.

The information that you provide does not affect your prospects for employment, and is kept in strict confidence.

We appreciate that you might find this request intrusive and we regret this. Please be advised that we are required by law to keep such records and perform such analysis and your cooperation will contribute to the accuracy or our information.

Information on country and state of residence as well as how you learned about this vacancy will assist us in our recruitment efforts.

The categories listed below are those used by the United States Bureau of the Census and the United States Department of Labor.

 
Sex

Ethnic Group

 
AFFIRMATIVE ACTION SURVEY DEFINITIONS
 

ETHNIC GROUP

Black: Persons with origin in any black racial group of Africa

Asian/Pacific Islander: persons with origin in the Far East, South East Asia or the Pacific Islands. (Includes Chinese / Chinese American, Japanese / Japanese American, Filipino, Pakistani, or East Indian.

Native American/Alaskan Native: Persons with origin in North America, including Eskimos and Aleuts, who maintain cultural identification through tribal affiliation or community recognition.

Hispanic: Persons with origin in Mexico, Central America, South America, Cuba, Puerto Rico and Spain. (Includes black individuals of Hispanic Origin).

White: Persons (other than hispanic) with origin in Europe, North America or the Middle East.

Name
County and state of residence
How did you learn of this vacancy?
If advertisement, please give name of publication:
Date of publication
Specific position applied for
Today's date
   
SUBMIT APPLICATION
 

CONSENT TO ELECTRONIC TRANSACTION

You consent and agree that your use of key pad, mouse, or other device to select an item, button, icon, or similar act/action while using any electronic service we offer, or in accessing or making any transactions regarding any agreement, acknowledgement, consent, terms, disclosures or conditions constitutes your signature, acceptance and agreement as if actually signed by you in writing.

Thank you for your interest in Televerde.