EMPLOYMENT APPLICATION     
Starin Marketing, Inc.

Starin Marketing, Inc. is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other status protected under local, state or federal laws.

Position(s) Applied For

Date of Application

First Name  Middle Name Last Name

Address   City  State    Zip Code

Telephone Number   Alternate

Social Security Number (If available)

How Did You Hear About Us? Newspaper Ad Employment Agency
Current Employee Other

Are you legally eligible to work in the United States?
(Proof of eligibility will be required upon offer of employment)

YES NO

Are you over the age of 18 years? (If no, you may be required to provide authorization)

YES NO

Can you with or without reasonable accommodation perform the essential functions of this job? (If you have any questions about the functions of the job, please ask the interviewer before answering this question.)

YES NO

Have you ever applied to Starin Marketing, Inc. before? (If Yes, please give date.)

YES NO

Have you ever worked for Starin Marketing, Inc. before?

(If Yes, please give date.)

YES NO

Do you have a valid driver's license?(For driving positions only.)

YES NO

Is anyone related to you employed by Starin Marketing, Inc.?

YES NO

If Yes, please give their name and relationship to you.

What salary or rate of pay do you expect to receive if employed?       per

Have you ever been fired or asked to resign from a job?

YES NO

If Yes, please explain:

On what date would you be available to work?

 

EDUCATION

 

Name and Location of School

Course of Study or Major

# of Years
Completed

Diploma/
Degree

Elementary

High School

College

Graduate

Vocational


Please list any academic honors, scholarships, offices held, etc.(Do not list any which reflect your race, color, religion, gender, national origin, age, disabilities or veteran status.)


Describe any specialized training, apprenticeships, licenses or skills.


Have you received any job-related training in the
United States Military?    YES NO
Please give dates and explanation:

 

EMPLOYMENT HISTORY (Begin with current or most recent employer. Do not exclude any employment. Include any applicable temporary employment attach another sheet if necessary. Previous salaries or wages will not be used to determine compensation at Starin Marketing, Inc.)

Company Name   

Employment Dates
From 

To

Salary
Start 
End

Name and Title of Supervisor

Phone

Address

Describe your duties:

Reason for leaving and explanation

Company Name   

Employment Dates
From 

To

Salary
Start 
End

Name and Title of Supervisor

Phone

Address

Describe your duties:

Reason for leaving and explanation

Company Name   

Employment Dates
From 

To

Salary
Start 
End

Name and Title of Supervisor

Phone

Address

Describe your duties:

Reason for leaving and explanation

Company Name   

Employment Dates
From 

To

Salary
Start 
End

Name and Title of Supervisor

Phone

Address

Describe your duties:

Reason for leaving and explanation


Please provide any other information that you feel will help us in considering your application for employment.

 

REFERENCES (Please list three persons, who are not related to you or previous supervisors, who can provide professional references.)

Name   

Address    

Phone Number

Relationship/Occupation

Years Known

 

APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION

*PLEASE READ CAREFULLY BEFORE SUBMITTING*

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Starin Marketing, Inc. (hereinafter referred to as "Starin Marketing") that such employment with Starin Marketing is at will, for no specified duration and may be terminated by either Starin Marketing or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Starin Marketing or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of Starin Marketing except the President has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President of Starin Marketing, Inc.

In consideration for employment with Starin Marketing, if employed, I agree to conform to the rules, regulations, policies and procedures of Starin Marketing at all times and understand that such obedience is a condition of employment. I understand that due to the nature of Starin Marketing business, attendance and punctuality are considered essential requirements of every job at Starin Marketing and that poor attendance or tardiness will result in disciplinary action.

I understand that if offered a position with Starin Marketing, I may be required to submit to a pre-employment background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

I herby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Starin Marketing and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.

I understand that this application is considered current for three months. If I wish to be considered for employment after this period I must fill out and submit a new application.

BY SUBMITTING BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.


Full Name                                                                                 Date

Name and number of person completing this form if other than applicant:

STARIN MARKETING, INC. IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, VETERAN STATUS OR ANY OTHER STATUS PROTECTED BY LAW.