Quality Hill Associates

Please take the time to fill out this online application. Our staff at Quality Hill Associates will review your application and begin your placement process.

PERSONAL INFORMATION

Name:

Address:

City:

State:

Zip:

Phone:

Are you 18 years or older?* Yes No

* The Age Discrimination Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.

SPECIAL QUESTIONS

Yes No	Are you prevented from lawfully becoming employed in the U.S.?
Yes No	Have you been convicted of a felony or misdemeanor within the last 5 years**? If yes describe below:

** You wil not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.

EMPLOYMENT DESIRED

Position Desired:

Date You Can Start:

Salary Desired:

Are you employed now?

Yes No

If so may we contact your present employer?

Yes No

Have you ever applied to this company before?†

Yes No

†If so, when?

EDUCATION

Name and Location of School

Yrs

Grad. (Yr)

Grammar School:

High School:

College:

Trade Business
School:

General subjects of special study or research work

U.S. Military or Naval Service? Yes No

Membership in Naval Guard / Reserve Yes No

Present Rank:

EMPLOYMENT HISTORY

JOB #1

Dates: From: To:

Name and Address
of Employer:

Title:

Salary:

Reason for Leaving:

JOB #2

Dates: From: To:

Name and Address
of Employer:

Title:

Salary:

Reason for Leaving:

JOB #3

Dates: From: To:

Name and Address
of Employer:

Title:

Salary:

Reason for Leaving:

REFERENCES

Give the names of three persons not related to you, whom you have known at least one year.

	Name and Address	Telephone	Business	How Long
1.
2.
3.

LIMITATIONS

Yes No

Do you have any physical limitations that preclude you from performing any work for which you are being considered?

Please describe:

In case of
emergency notify:

Phone:

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my preious employment and any pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.