APPLICATION FOR EMPLOYMENT DUREN & ASSOCIATES LLC 1045 12TH Ave NW #F5 Issaquah, WA 98027 425-369-1671 425-369-1703 FAX	EQUAL EMPLOYMENT OPPORTUNITY. It is our policy to seek and employ the best qualified personnel and to provide equal opportunity for the advancement of employees and to administer all of our personnel policies in a manner that will not discriminate against any person because of race, color, religion. age, sex, marital or veteran status, national origin, ancestry, disability, on the job injuries, union affiliation, or any other legally protected status unless it is a bona fide occupational requirement reasonably necessary to the operation of our business.
YOUR INFORMATION: First Name: Last Name: Phone: Address: City, State: Zip: Email:         Apply for Position(s): Rate Expected: Date Available:         Referred by: Newspaper Employee On My Own School Agency Other: Have you ever worked for us before? Yes No If yes, where? If yes, when? Are you available for work every day of the week? (We will attempt to reasonably accommodate employees who require certain hours or days off because of religious beliefs or practices.) Yes No Check shifts you can work: Days Swing Graveyard Rotating Are you authorized to accept employment in the United States? (Successful applicants will be required to prove identity and eligibility for employment.) Yes No Are you at least 18 years of age? Yes No RELATIVES/FRIENDS: Some positions may not be held by certain individuals to avoid the possibility of conflicts of interest. Qualified relatives/friends are eligible for employment except in those unusual situations (for example, where they would be placed in a supervisor-subordinate relationship). Do you have any relatives or friends (such as roommates) who currently work for us? Yes No If yes, please state his/her name(s): QUALIFICATIONS: Please list ALL education, training and/or specialized experience (such as schools; colleges; degrees; licenses; vocational, technical, or military experience; hobbies, etc.) you feel would help you perform the work for which you are applying (ie DEGREES, LICENSE, RELEVENT EDUCATION OR TRAINING: WHERE AND WHEN DID YOU ACQUIRE IT?, Name and address of school, program, military branch and specialty, etc...): CRIMINAL RECORD: (Conviction or a crime is not an automatic bar to employment. Factors such as the nature and gravity of the crime, the length of time since the conviction and/or completion of any sentence, and the nature of the job for which you have applied will be considered.) (WASHINGTON APPLICANTS: Do not list any conviction for which the date of conviction or prison release, whichever is more recent, is more than seven years old.) Have you ever been CONVICTED, pled GUILTY or NO CONTEST or FORFEITED BOND OR BAIL for any crime other than traffic violations? Yes No If yes, give details: DRIVING POSITIONS: If the position applied for involves driving: Do you have a valid WA state drivers license? Yes No Have you ever been CONVICTED, pled GUILTY or NO CONTEST or FORFEITED BOND OR BAIL for any traffic violations in the past three years? Yes No If yes, give details: IN CASE OF EMERGENCY NOTIFY: Name: Address: Phone: PREVIOUS EMPLOYMENT: (list from most recent to oldest)   Employer Phone Supervisor Dates Employed hired left Pay Rate start end Address Reason for Leaving Job Title/Duties:   Employer Phone Supervisor Dates Employed hired left Pay Rate start end Address Reason for Leaving Job Title/Duties:   Employer Phone Supervisor Dates Employed hired left Pay Rate start end Address Reason for Leaving Job Title/Duties:   Employer Phone Supervisor Dates Employed hired left Pay Rate start end Address Reason for Leaving Job Title/Duties:   Employer Phone Supervisor Dates Employed hired left Pay Rate start end Address Reason for Leaving Job Title/Duties:   VERIFICATION AND SIGNATURE: 1. I authorize the investigation of all matters which the Company deems relevant to my qualifications for employment, including all statements made in this application and in any attachments or supporting documents. I authorize you to request and receive such information and I release from all liability any persons (such as former supervisors) or employers supplying it. I also release you from all liability which might result from making the investigation. 2. I certify that the facts and information in this application and in any attachments or supporting documents are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission, as well as any misleading statements or omissions, generally will result in denial of employment or immediate termination, regardless or when and how discovered. I also understand that providing information other than that requested on this application will result in the disqualification of this application. 3. I understand that I may be required to submit to employment physical or other professional examinations, medical inquiries and/or urinalysis tests for the presence of drugs and/or alcohol. I agree to such examinations, inquiries and/or testing at the Company’s expense. I authorize release of the results to the Company and their use to evaluate my suitability for employment. I also release the Company from all liability arising out of or connected with any examinations, inquiries and/or testing. 4. I understand that I may resign or be terminated, without cause or notice, at any time, unless otherwise stated in an employment contract. I also understand that Duren & Associates LLC and its designated agents are the only people who will ever have the authority to agree to any other terms and/or to enter into such contracts and that all such agreements for other terms of employment or contracts must be in writing and signed by both parties. I also understand that unless otherwise stated in an employment contract, the Company may change, withdraw and interpret other policies (including wage, hours, and working conditions) as it deems appropriate. 5. I authorize Duren & Associates LLC and its designated agents and representative to conduct a comprehensive review of my background causing a consumer report and or an investigative consumer report to be generated for employment purposes. 6. This original application for employment will only be considered for 30 days. 7. I have read each of these statements. I have also reviewed all of the information provided in this application and in any supporting documents. Yes Full Name: Date: