Employment Application – by RLS
Employment Application – by RLS
Position Applied For
Human Resources Generalist (Central AR)
Outside Sales Rep (Central AR)
UDS / Phlebotomy Collector – PRN – Central AR
UDS / Phlebotomy Collector – PRN – Jonesboro
UDS/Phlebotomy Collector-PRN Hot Springs, AR
UDS/Phlebotomy Collector-PRN West Memphis, AR
Position Applied For
Today’s Date
Availability
Select all days you are available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday available from
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Tuesday available from
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Wednesday available from
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Wednesday available to
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Thursday available from
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Thursday available to
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Friday available from
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Friday available to
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Saturday available from
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Saturday available to
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Sunday available from
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Sunday available to
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If hired, when could you begin work?
How many hours would you like to work each week?
Personal Information
Last name
First name
Middle initial
Email
Address
City
State
Zip code
Home phone
Cell phone
Work phone
May we contact you at work?
Yes
No
Are you over the age of 18?
Yes
No
Have you ever been employed under any other name(s)?
Yes
No
If yes, list other name(s)
How did you hear about this job opening?
Web page
Newspaper
Human resource office
ARMO employee
Career fair
Other
If “ARMO employee,” please list their name
If “other,” please explain
Are you authorized to work in the U.S.?
Yes
No
If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986
Education
High School
Number of years complete
Graduated
Yes
No
If no, highest grade completed?
Degree and major
College
Number of years complete
Graduated
Yes
No
If no, approximate number of credit hours completed?
Degree and major
Other
Number of years complete
Graduated
Yes
No
If no, approximate number of credit hours completed?
Degree and major
Skills
Office and computer skills
Transcription
Ten key by touch
Typing
Words per minute
Software applications
Microsoft Office
Other
Other
Licenses and Certifications
Are you currently
Registered
Licensed
Certified
Not applicable
Are you eligible for
Registration
Licensure
Certification
Not applicable
Professional License, Certification, or Registration
State
ID number
Expiration date
Professional License, Certification, or Registration
State
ID number
Expiration date
Military Service
Complete this section if you served in the U.S. Armed Forces
Branch of service
Date of service from
Date of service to
Describe duties and any special training
Rank at discharge
Discharge status
Honorable
Dishonorable
Other
Other
Employment History
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List all employment including military and volunteer service starting with the most current position held. Show employment history for at least 10 years or from the time you left school. Explain gaps in employment history. You may attach a resume, but you must complete the employment section. This information will be used in reference checks. Failure to answer all items in the following sections may eliminate you from further consideration.
Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 2
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Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 3
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Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 4
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Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 5
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Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 6
arrowup6
Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 7
arrowup6
Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Excluding minor traffic offenses, have you been convicted of a crime or received a suspended imposition or execution of sentence for a crime, in the past (10) years?
Yes
No
If yes, please provide the date you were convicted or were given a suspended imposition or execution of sentence, the sentence, and the crime for which you were convicted or were given a suspended imposition or execution of sentence.
Are you currently using illegal drugs or controlled substances not prescribed by a physician?
Yes
No
The type and seriousness of any crime, any drug use, along with your entire work history, education history and the position for which you are applying will be considered. A “Yes” response to the above questions will not automatically disqualify you from consideration for employment with Helix Specialty Diagnostics.
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Please Read Here and Sign
1. I certify that the information contained in this application is true and complete to the best of my knowledge and I understand that any misrepresentation or omission of facts is grounds for refusal to hire, or, if hired, immediate dismissal. 2. I affirm, under the penalty of law, that I have a genuine interest and intent to work for ARMO, that I have no other purpose or motive for applying for or accepting a position with ARMO, and that I will not disclose ARMO’s confidential information obtained during the interview process or during employment. 3. I hereby authorize ARMO to request each employer, person, company or school referenced in my Employment Application to answer all questions that may be asked and to give all information that may be sought in connection with my Application or concerning me or my work habits, character, skill or action in any transaction, and hereby authorize any persons or organizations referenced in the Application to provide ARMO with any and all information concerning my previous or current employment, education or other information they might have, personal or otherwise. Any information obtained by ARMO from any source will be held confidential by ARMO from all persons and even against any demand made by me, except as required by law. I understand that any offer of employment is contingent upon a successful background check. 4. I hereby release all parties from any liability for any damage caused or claimed to have been caused by giving and receiving opinions as to my previous or current employment, education and character. 5. I understand that any offer of employment may be subject to my satisfactory completion of a post-offer drug/alcohol test. A blood test, urine screen or any other drug/alcohol screen may be required at any time pursuant to ARMO’s substance abuse policy and as permitted by applicable law. I acknowledge and agree that the pertinent results of such post-offer, pre-employment drug/alcohol screen and/or physical medical examination and the pertinent results of any post-employment drug/alcohol screen and/or job-related physical or medical examinations may be used to make decisions affecting my employment application and/or continued employment, as applicable. 6. I acknowledge that no officer, agent, or employee of the company has made any representations or promises to me concerning the length, duration, kind, character or nature of employment or compensation which may be offered to me, and I further agree that I have not and shall not base any decision to relocate my residence upon any representations of such nature. 7. I further understand that my Application will remain active for 90 days from the date it was completed, and that, if I am not offered employment within 90 days and wish to be considered for employment after the 90 day period has expired, I must reapply.
Electronic Signtature
Date
Applicant name
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