Employment

Would you like to complete an employment application?*
- Yes
Application for Employment
Thank you for your interest in applying for a position with our company. We want to have a complete understanding of your qualifications and interests so we can make careful and deliberate hiring decisions that will benefit the company, you, and all of our employees. Please answer the questions honestly, completely, and thoughtfully.

We are an equal employment, affirmative action employer. All applicants are considered for employment based upon their qualifications, without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of non-job-related medical disability or handicap.
Date*
Position(s) Applied For*
Personal Information
Name*
First Middle Last
Address*
Street Address City State ZIP Code
Phone*
Restrictions
Please specify any restriction on your work schedule (i.e., days of the week, hours of the day you cannot work).
Do you know anyone who works here?*
- No
- Yes
Who?*

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Education/Training
High School*
Name, City, & State of School
Course of Study
Years Completed
Degree/Diploma
College
Name, City, & State of School
Course of Study
Years Completed
Degree/Diploma
Graduate School
Name, City, & State of School
Course of Study
Years Completed
Degree/Diploma
Trade/Technical School
Name, City, & State of School
Course of Study
Years Completed
Degree/Diploma
Other
Name, City, & State of School
Course of Study
Years Completed
Degree/Diploma

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References
List the names of any professional or personal character references who have known you for the last three years and from whom you can obtain a letter of recommendation. Please do NOT list relatives.
Reference 1 - Name*
First Last
Occupation*
Address*
Street Address City State
Phone*
Reference 2 - Name*
First Last
Occupation*
Address*
Street Address City State
Phone*
Reference 3 - Name*
First Last
Occupation*
Address*
Street Address City State
Phone*

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Please Read the Following Paragraphs Carefully
I certify that all the information I have supplied on this application is true, accurate, and complete to the best of my knowledge and that I have not knowingly withheld any information that, if known to the company, would affect my application unfavorably. I understand that any false, misleading, and/or incomplete statements on this application and/or in any interview, constitute sufficient cause for the company not to employ me or, if I am employed, to terminate my employment.
I authorize an investigation to be conducted concerning all of the information I have supplied on this application and all other information that the company deems to be relevant to my qualifications for employment. I further authorize my present employer, any former employer, any educational institution, any law enforcement organization, any professional or personal reference, or any other appropriate source or individual to provide all information that is requested in connection with such investigation. I release the company and all named and unnamed sources from any and all liability that may result from furnishing information concerning me.

This employment application will be considered active for ninety (90) days from the date below. If I want to be reconsidered for the position with the company after this time, I will fill out a new application.

I agree to take any lawful examination or test, including any drug and/or alcohol test, required by the company as a condition of my being hired or, if I am hired, as a condition of my continued employment. I further agree that my refusal to take any such lawful examination or test will constitute sufficient cause for the company not to employ me or, if I am employed, to terminate my employment. I release the company and all other named and unnamed sources from any and all liability that may result from any lawful examination or test.

If I am employed, I agree that, in consideration of my employment, I will conform to the rules and regulations of the company. I understand that those rules and regulations may be altered, amended, or repealed by the company at any time, at the company’s sole option and without any prior notice to employees. If I have any dispute with the company, I agree that I must bring such claim within six (6) months from my leaving the company's employment or any claims are waived and released.
I acknowledge that, if I am employed, my employment and compensation can be terminated at any time, with or without cause or notice, at the option of either the company or myself. I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, to assure any benefits or terms and conditions of employment, or to make any agreement contrary to the foregoing.
Read & Agree*
I have read, understood, and agree to the above paragraphs.
- No
- Yes

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Employee Information Form
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Date of Birth*
MM
DD
YYYY
Social Security Number*
Driver's License Number*
Consumer Reports may be obtained as part of K.E. McCartney & Associates, Inc.'s (KEM's) employer evaluation of my job application/employment. The reports may be procured by KEM’s General Insurance Agency and may include my driving record, assessment of my insurability under the company’s insurance coverage, or other consumer reports. By signing this disclosure, I hereby authorize the company to procure such reports and additional reports about me from time to time, as it deems appropriate, to evaluate my insurability or for other permissible purposes.
Agreement*
I agree to the above paragraph.
- No
- Yes

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Applicant Data Record
Note: This is NOT part of the employment application.
All applicants are considered for all positions and employees are treated during employment without regard to race, color, religion, sex, national origin, age, disability, handicap, and marital or veteran status. However, as a consultant having obligations with state and federal agencies, we are required to comply, and do comply, with governmental regulations and affirmative action responsibilities.
In order to help us comply with governmental record keeping, reporting, and other legal requirements, this applicant data record is requested but will not be maintained as part of any application for employment.
Position Applied For
Referral Source
Name
First Middle Last
Address
Street Address City State ZIP Code
Phone
Social Security Number
Sex
Race/Ethnic Group
Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals with Physical or Mental Handicaps
Government contractors are subject to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974, which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.
If you wish to be identified, please indicate below.

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Acknowledgment
Signature*
By selecting "Yes" below, you are electronically signing your application as of the date of this application. Do you want to sign the application?
- No
- Yes
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Submit Resume

Application

Step 1 of 9

Application for Employment

Personal Information

Education/Training

Employment Experience

Additional Employment Experience

Additional Employment Experience

Military Service

Miscellaneous Information

References

Please Read the Following Paragraphs Carefully

Employee Information Form

Applicant Data Record

Acknowledgment

Current Open Positions

Resume