First Name*
Last Name*
Email Address*
Phone*
Who referred you to this position? Enter their first and last name here.
What's your citizenship / employment eligibility?*
No answer I am a U.S. Citizen/Permanent Resident Non-citizen allowed to work for any employer Non-citizen allowed to work for current employer Non-citizen seeking work authorization I am a Canadian Citizen/Permanent Resident Other
What's your highest level of education completed?*
No answer GED or Equivalent High School Some College College - Associates College - Bachelor of Arts College - Bachelor of Fine Arts College - Bachelor of Science College - Master of Arts College - Master of Science College - Master of Fine Arts College - Master of Business Administration College - Doctorate Medical Doctor Other
Are you 18 years of age or older?*
No answer Yes No
Desired salary*
Earliest start date?*
Can you work weekends?*
No answer Yes No
Can you work evenings?*
No answer Yes No
Can you work overtime?*
No answer Yes No
Have you ever been convicted of a felony?*
No answer No Yes
If “Yes”, you have been convicted of a felony, please explain the circumstances around the conviction:
Have you ever worked for Impact Workforce Solutions in the past?*
-- No answer -- Yes No
I understand and certify that all information supplied in this application, and any attached resume, is complete and correct. Any false, misleading or incomplete information furnished by me regarding this application may result in the rejection of this application or if employed, dismissal. I understand that in consideration of my employment, I agree to conform to the rules and regulations of the Employers, and further agree that my employment and compensation are at the will of the Employers and can be terminated, with or without cause, and with or without notice, at any time at the option of either the Employers or myself. I understand and agree that these terms can only be modified in writing and signed by the President. No supervisor, representative, agent, or other employee of the Employers has now or has had in the past the authority to enter into any agreement for employment for a specified period of time, or to make any agreement which is contrary to or in modification of the above terms, nor can any policies or practices of the Employers either written or oral, modify the above terms.*
-- No answer -- I Agree I Disagree
I understand and agree to take any physical examination, and pre-employment test, including drug screening test, all such tests will be administered in compliance with the Americans With Disabilities Act.*
-- No answer -- I Agree I Disagree
I understand and hereby authorize all persons, schools, companies, employers, and/or their representatives to furnish verification to the Employers, its representatives or agents, any and all information set forth in this application and/or attached resume. In addition, I hereby agree to hold harmless and to release from all liability all said persons, schools, companies, employers and/or their representatives from any and all claims that I may have, or which may arise, against any and/or all of them, including the Employer, as a result of them furnishing information to the Employers. I authorize the Employers, should they employ me, to release employment references, if my employment becomes terminated for any reason. I also authorize the Employers to conduct credit, police, criminal and driving record inquiries, or any other employment related inquiries in compliance with the provisions of the Fair Credit Reporting Act, 15 U.S.C. Section 1681, et. seq.*
-- No answer -- I Agree I Disagree
I understand that the decision to hire me and my continued employment will be subject to the results of these inquiries.*
-- No answer -- I Agree I Disagree
I understand this application will be active for employment consideration for 30 days. After 30 days, if I wish to be considered for employment, I must contact the Employers to determine if applications are being accepted.*
-- No answer -- I Agree I Disagree
Invitation for Job Applicants to Self-Identify as a U.S. Veteran
A “disabled veteran” is one of the following:
a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
a person who was discharged or released from active duty because of a service-connected disability.
A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Voluntary Self-Identification of Disability
Voluntary Self-Identification of Disability Form CC-305
Why are you being asked to complete this form?
How do you know if you have a disability?
