READ THIS FIRST: This application form is intended for use in evaluating your qualifications for employment. This is not an OFFER OF EMPLOYMENT, JOB OFFER, EMPLOYMENT CONTRACT OR EMPLOYMENT AGREEMENT. An extensive Background Investigation, including State Required Fingerprinting plus a Drug Test will be performed and made part of your application. False and/or misleading statements made during the interview process and/or on this form are grounds for terminating the application or, if discovered after employment, terminating employment. INSTRUCTIONS: Answer each question truthfully. No action will be taken on your application until you have answered all questions. In addition to completing this application, please email your Resume to: [email protected].
Today’s Date:
Name:
[First]
[Middle]
[Last]
Street Address
Town
State
How Long There
Home Telephone
Prior Address
Town
State
How Long There
Cellular Telephone
Are You a U.S. Citizen? YesNo
[Proof of identity and United States Citizenship is a condition of employment.]
Date available to begin (mm/dd/yyyy): Requested salary: $ FULL TIME WORK ONLY–NO PART TIME. IF YOU AGREE, TYPE THE WORD AGREE:
Have you ever previously applied to any of our companies? YesNo Have you EVER been Employed by us? Yes No Do you have any Friends or Relatives employed by us? Yes No
Have you ever been convicted of a Crime, which would be prohibited employment in accordance with either the NJ Private Detective Act or the NY General Business Law? YesNo
Have you ever been suspended or terminated from any job?Yes No[If yes, please explain]:
Do you have a valid driver’s license?Yes No
RECORD OF EDUCATION
Type of School
Name/Location of School
Years Attended
Major
Diploma/Degree or Certificate
High School
College
Other
MILITARY RECORD
Are you a veteran of the United States Armed Forces?YesNo If yes, Honorable Discharge?YesNo
If yes, do you have a DD214, YesNo? What Unit were you in?
PRESENT AND PAST EMPLOYMENT [List most recent employment first]
1. Name of Company
Telephone #:
Person Reported To & Title:
Street Address:
City/State:
Period Employed [Month/Year]:
From:To:
Position/Title:
Salary:
Start: $End: $
Your Duties/Responsibilities:
Reason for leaving:
2. Name of Company
Telephone #:
Person Reported To & Title:
Street Address:
City/State:
Period Employed [Month/Year]:
From:To:
Position/Title:
Salary:
Start: $End: $
Your Duties/Responsibilities:
Reason for leaving:
3. Name of Company
Telephone #:
Person Reported To & Title:
Street Address:
City/State:
Period Employed [Month/Year]:
From:To:
Position/Title:
Salary:
Start: $End: $
Your Duties/Responsibilities:
Reason for leaving:
4. Name of Company
Telephone #:
Person Reported To & Title:
Street Address:
City/State:
Period Employed [Month/Year]:
From:To:
Position/Title:
Salary:
Start: $End: $
Your Duties/Responsibilities:
Reason for leaving:
Do you authorize us to contact your present employer?YesNo
You must speak and write ENGLISH. What other languages to you speak?
Special interests or hobbies:
Why are you applying to INVESTICORP, INC. (NY) OR DAVID ROSE INTERNATIONAL, INC. (NJ)?
Email address:
PRELIMINARY RELEASE, FOR ELECTRONIC APPLICATION:
I certify that I have PERSONALLY PREPARED this application. I agree to complete and sign multiple additional and more detailed releases, at an in-person interview. I have read and understand all instructions and notes on this form and that the answers given by me to all questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand any false information, omissions or misrepresentations of facts, whether on this document or not, may result in rejection of my application or termination, at anytime during my employment. I authorize INVESTICORP, INC. (NY) OR DAVID ROSE INTERNATIONAL, INC. (NJ) and/or its agents, including consumer reporting bureaus, (Credit Reports will NOT be obtained on NEW YORK CITY Applicants who reside in and will be employed in NEW YORK CITY), to verify ALL of this information. I hereby fully and unconditionally release INVESTICORP, INC. (NY) OR DAVID ROSE INTERNATIONAL, INC. (NJ) and its agents and all persons, agencies and entities providing information, including past employers, schools, probation departments, motor vehicle departments and any other government agency, reports about me from any and all liability, arising out of the request for or releasing any of the above information or reports. I also understand that the abuse of prescription drugs or alcohol use of illegal drugs, is prohibited prior to or during employment. I am willing to submit to drug testing to detect the abuse of prescription, or use of illegal drugs, prior to and during employment. I consent to being Live Scanned Fingerprinted, as REQUIRED by New York and New Jersey Laws.
INVESTICORP, INC. (NY) OR DAVID ROSE INTERNATIONAL, INC. (NJ) are at-will organizations, in accordance with NY & NJ Laws. I understand and agree that this application does not create a guarantee of employment, or an Employment Contract, which can only be accomplished in person, which must be then countersigned by a Corporate Officer. I agree that prior to employment I will execute an official Employment Contract, it a position is offered by INVESTICORP, INC. (NY) OR DAVID ROSE INTERNATIONAL, INC. (NJ)
Electronic Signature Date:
I agree my name above this line is the legal equivalent of my signature.
