Information Capture Solutions is an equal opportunity employer.
All statements made by applicants for employment on this application form will be checked for accuracy. We offer equal employment opportunities to all persons without discrimination on the basis of race, color, religion, age, sex, national origin, citizenship status, physical or mental disability, or past, present, or future service in the Uniformed Services of the U.S. or any other legally protected status. The use of this form does not mean there are positions open and does not obligate us in any way.
Your Details Email * Phone * Previous Address (If at current address for less than one year) Social Security Number Are you at least 18 years of age? *
Employment is subject to verification of minimum legal age.
Can you produce documented proof of your identity and eligibility for employment in the United States? *
Examples: driver’s license, Social Security card, birth certificate, and/or Immigration and Naturalization Service Documents.
Name of Emergency Contact *
Who should we contact in case of an emergency?
Emergency Contact Phone * Position Details Position Applying For * How soon could you report to work? * Type of employment desired: * Rate of pay expected: If you have a resume, you may upload it here in PDF format (optional):
You may upload your resume in PDF format.
Education Details Name of the High school you attended: * Where is the High school located? (City, State) * Please select the highest grade of non-college education completed * Did you attend college? * Application & Employement Details Have you applied for a job with us before? * Have you ever worked for us before? * How did you come to apply? * Have you ever been bonded? * Have you ever been refused a bond? * Have you ever been convicted of a violation of the law except a minor traffic violation? *
A conviction will not necessarily disqualify you from employment.
Have you ever been discharged or requested to resign from a position? * Are you currently employed? * Have you ever held a position of trust (handling money or confidential material)? * Do you have any reason to believe that you would have difficulty meeting this company's work schedules? * Please provide any additional information such as special skills, training, experience, equipment operation, or other qualifications you feel will be helpful to us in considering your application: Employment History Company / Business Name of most recent employer: * Name of Supervisor at most recent employer: * Address of most recent employer: * Phone Number for most recent employer: * Are you still employed with this company? * Starting pay rate: Current / Final pay rate: Please provide your job title, along with a description of your duties & responsibilities: * May we contact this employer? * Company / Business Name of 2nd most recent employer: Name of Supervisor at 2nd most recent employer: Address of 2nd most recent employer: Phone Number for 2nd most recent employer: Are you still employed with this company? Starting pay rate: Current / Final pay rate: Please provide your job title, along with a description of your duties & responsibilities: May we contact this employer? Company / Business Name of 3rd most recent employer: Name of Supervisor at 3rd most recent employer: Address of 3rd most recent employer: Phone Number for 3rd most recent employer: Are you still employed with this company? Starting pay rate: Current / Final pay rate: Please provide your job title, along with a description of your duties & responsibilities: May we contact this employer? Data Entry Experience Are you applying for a data entry position? Job Applicant’s Agreement and Certification
“I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.”
“I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between the company and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the company unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that the company retains the same right.”
“If I am offered employment, I agree to submit to a physical examination whenever requested, and I understand my becoming employed and/or my continued employment is subject to the results of any physical examination related to my job duties. In accordance with company policies and procedure.”
“I understand that if employed, policies, and rules which are issued are not conditions of employment and that the employer may revise policies or procedures in whole or part, at any time.”
“I understand that this application will be kept on active file for a limited number of days from the date completed, after which time I would have to reapply in accordance with established company procedures.”