Application for Employment
PLC Services, Inc APPLICATION FOR EMPLOYMENT
QUESTIONS IN BURGUNDY INK MUST BE ANSWERED IN THEIR ENTIRETY.
PLEASE PRINT ALL ANSWERS CLEARLY.
|Last Name||First Name||Middle Name||Social Security||Todays Date|
|(please use Legal Name as it appears on your Social Security Card)|
|Home Phone Number||Cell Phone Number||Email Address|
|Only U.S. citizens or aliens who have a lega! right to work in the U.S. are eligible for employment.|
|Can you, upon employment, submit documentation verifying your identity and your legal right to work in the U.S.?||Yes||No|
|Have you ever been convicted of a felony?||Yes||No|
|Note: A conviction will not necessarily disqualify you from employment.
If “yes” •. complete the “Felony Conviction” form which can be obtained from your potential On-Site Supervisor,
If you responded “Yes”, the Felony Conviction explanation form must accompany this application for
|Are you over 18 years of age?||Yes||No|
|Position applying for:|
|Are you able to perform the essential functions of the job?||Yes||No|
|If “no”, are there reasonable accommodations that can be made to allow
you to perform the essential functions of the job?
IMPORTANT ~ IN CASE OF EMERGENCY NOTIFY:
I have read and ‘understand the Notice to Applicants and the Applicant’s Statement on the inside page of this application packet. This application will remain active for thirty (30) days Any applicant wishing to be considered for employment beyond thirty (30) days should reapply.
Please print, fill, and email to firstname.lastname@example.org
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