12345678 Position* NAMEFirst* Last* M.I.* Please indicate any other name(s) under which you have worked or attended school (this information is necessary to verify your qualifications for the job applied for if you attended school or worked under another name)Other name(s) PERMANENT ADDRESSAddress* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* MILITARY SERVICEHave you ever served in the armed forces of the United States of America? Yes No If yes, which branch? Served From MM slash DD slash YYYY Served To MM slash DD slash YYYY Do you understand the requirements of the position you are applying for?* Yes No If you are under 18, can you provide required proof of your eligibility to work? Yes No Are you presently authorized to work in the United States or Canada on a full-time basis? (Proof of citizenship or immigration will be required upon employment) Yes No Will you now, or in the next 3 years require Frontage Laboratories to provide sponsorship, or continue a current immigration case in order to legally employ you in the United States?* Yes No Have you ever been convicted of or pleaded guilty to a FELONY offense, excluding traffic offenses? Yes No A “yes” answer will not necessarily disqualify you from consideration. Please explain your answer of “yes” so that individual circumstances can be considered.Have you previously applied to or been hired for a position with Frontage Laboratories? Yes No If yes, please indicate date, position applied for or heldReferred by Agency Website Own Initiative Ad Employee Agency Name Employee Name EDUCATIONAL BACKGROUNDIf name was different on school records, please indicate name High SchoolName City State Did you graduate? Yes No Major/Degree Received College or UniversityName City State Did you graduate? Yes No Major/Degree Received Other (include Graduate School, Military & Equivalence Diploma)Name City State Did you graduate? Yes No Major/Degree Received EMPLOYMENT HISTORYPlease begin with present Employer or most recent Employer and include military history if any as part of your employment history. Note: List Employers in reverse order starting with the most recent.Employer 1Name of Company* Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Job Title* Employed From* MM slash DD slash YYYY Employed To* MM slash DD slash YYYY Starting Salary*Ending Salary*Immediate Supervisor (Name, Title & Phone)*Describe Job Duties*Reason For Leaving*Explain any period between jobsMay we contact Employer Yes No Would you like to add another Position?* Yes No Employer 2Name of Company Address Street Address City State / Province / Region ZIP / Postal Code PhoneJob Title Employed From MM slash DD slash YYYY Employed To MM slash DD slash YYYY Starting SalaryEnding SalaryImmediate Supervisor (Name, Title & Phone)Describe Job DutiesReason For LeavingExplain any period between jobsMay we contact Employer Yes No Please list special accomplishments, publications, awards etc... (Exclude information that would reveal race, color, religion, sex, national origin, citizenship, age, mental, or physical abilities, veteran/reserve national guard or any other similarly protected status.) OPTIONALQualified applicants are considered for employment without regard to race, religion, sex, national origin, age, marital status, sexual orientation, veteran status, disability, or other protected characteristic. Frontage Laboratories is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Frontage Laboratories invites employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. This form will be kept in a confidential file separate from your application for employment.Gender Identification (check one) Female Male Race/Ethnic Identification (check one): Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. If you did not check “Hispanic or Latino” above, please select one of the following race/ethnic identifications. White (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above five races. Decline self-identification Veteran's Group (check one) Non-Vietnam Era Veteran Vietnam Era Veteran Disabled Non-Vietnam Era Veterann Disabled Vietnam Era Veteran Veteran’s Widow-Widower Not a Veteran UPLOAD RESUME & COVER LETTERIf you already have your resume in MS Word, WordPerfect, etc., you can upload it to save time. If you do not wish to upload your resume, please complete the resume profile below. Attach File(s)Accepted file types: doc, docx, rtf, pdf, txt, html, Max. file size: 8 MB. ACKNOWLEDGEMENT I certify that the answers given by me to the foregoing questions and the statements made by me in connection with my application for employment with Frontage Laboratories are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misinterpretations of facts called for in this application process may result in rejection of my application or discharge at any time during my employment. I understand that consideration of employment is contingent upon the result of a reference check and may be contingent upon a background check, including inquiries concerning convictions. I therefore authorize Frontage Laboratories to investigate all statements made on this application and to discuss the results of its investigations with those responsible for hiring. I further authorize Frontage Laboratories to contact my former Employers, schools, companies, corporations, and law enforcement agencies and credit bureaus, or other persons who can verify or provide information on this application. I release from liability such Employers, schools, companies, corporations, law enforcement agencies, credit bureaus, or other persons contacted by, and providing information to, Frontage Laboratories. I agree to execute any required authorization to allow Frontage Laboratories to undertake such investigation. I understand that the use, purchase, transfer, possession, or sale, or being under the influence of, illegal drugs or controlled substances while on Company premises, the premise of any Company worksite or while engaged in Company business is strictly prohibited and is grounds for immediate discharge. I understand the federal regulations require that my employment be conditioned upon representation of documents at the time of hire which verify my identity and eligibility to work in the U.S. (i.e., passport, certificate of US citizenship or naturalization, alien registration card, driver’s license, US Military card, social security card, birth certificate, or other US employment authorization). If I accept employment with the Company, I understand it may be terminated at any time, at the will of Frontage Laboratories, with or without notice and with or without cause. Only a duly designated officer of the Company through a written contract has the authority to change the Frontage Laboratories at-will employment policy. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE ACKNOWLEDGEMENT. By adding my initials below, I certify that I have read, fully understand and accept all the terms of the foregoing acknowledgement. Applicants Signature (Initials)* Please only hit the submit button once.I AGREE* By submitting this form I agree that Frontage may process my data in the manner described in Frontage’s Privacy Policy.
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