Email Address



Employment Desired

Position applying for:



Personal Information

Have you ever applied to or worked for Probe Information Services before? Yes No
If yes, when?

Do you have any friends or relatives working for Probe Information Services? Yes No

If yes, state name(s) and relationship:

Name                                                Relationship


Name                                                Relationship


Why are you applying for work at Probe Information Services?


If hired, would you have a reliable means of transportation to and from work?
Yes No

If yes, tell us the year, make and model of your vehicle.

Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)
Yes No

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?
Yes No

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
Yes No

If no, describe the functions that cannot be performed.


(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana-related offenses that are more than two years old need not be listed.) Yes No

If yes, state nature of the crime(s), when and where convicted, and disposition of the case.


(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Education, Training, and Experience

High School

Name and Address                                         No. of Years Completed


Did you Graduate          Degree or Diploma
Yes No             

College/University

Name and Address                                         No. of Years Completed


Did you Graduate          Degree or Diploma
Yes No             

Vocational/Business

Name and Address                                         No. of Years Completed


Did you Graduate          Degree or Diploma
Yes No             

Health Care Training

Name and Address                                         No. of Years Completed


Did you Graduate          Degree or Diploma
Yes No             


Employment History
List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment.

Employer #1

Name of Employer                               Telephone Number


Type of Business                        Your Supervisor's Name


Address & Street


City                                         ST     Zip


Dates of Employment:  From             To
                               

Weekly Pay: Starting          Ending
                 

Your Position and Duties


Reason for Leaving


May we contact this employer for a reference?
Yes No


Employer #2

Name of Employer                               Telephone Number


Type of Business                        Your Supervisor's Name


Address & Street


City                                         ST     Zip


Dates of Employment:  From             To
                               

Weekly Pay: Starting          Ending
                 

Your Position and Duties


Reason for Leaving


May we contact this employer for a reference?
Yes No


Employer #3

Name of Employer                               Telephone Number


Type of Business                        Your Supervisor's Name


Address & Street


City                                         ST     Zip


Dates of Employment:  From             To
                               

Weekly Pay: Starting          Ending
                 

Your Position and Duties


Reason for Leaving


May we contact this employer for a reference?
Yes No


References
List below three persons not related to you who have knowledge of your work performance within the last three years.

Reference #1

Last Name                First Name               Telephone Number


Address & Street


City                                         ST     Zip

 
Occupation                                         No. of Years Acquainted



Reference #2

Last Name                First Name               Telephone Number


Address & Street


City                                         ST     Zip

 
Occupation                                         No. of Years Acquainted



Reference #3

Last Name                First Name               Telephone Number


Address & Street


City                                         ST     Zip

 
Occupation                                         No. of Years Acquainted




Employment Questionnaire

Tell us about yourself:

What special skills do you have that you feel would help you in this position?

What are your income requirements and expectations?


What are your long-range goals? What would you like to be doing five years from now?

What working environment makes you the happiest? What causes you stress?

What do you expect from your Employer?

What restrictions do you have on working every Saturday and Sunday, and some evenings?

If hired, when would you be available to begin working?

Please Read Carefully, Initial Each Paragraph

  I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

  I hereby authorize Probe Information Services to thoroughly investigate my references, work record, educationand other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

  I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.

  Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.

I waive receipt of a copy of any public record described in the paragraph above. Yes No