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*Last Name: *First, MI:
*Address: *Home Ph:
   Work Ph:
*City:  Mobile Ph:
*State:  Msg Ph:
*Zip Code:  Pager:
Email: Emergency Ph:
Desired Work Locations (Click add for each item desired location)  Add Selected Item
How did you hear about us?
If you have been referred by an employee or friend, please provide his/her name and/or email:
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Additional Documents

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Education
  Name of School
City and State
Graduated? Yes or No Degree Earned OR Credit Hours Earned
High School
Junior College
University
Graduate School



Work Information
Are you currently employed? Yes No
May we call you at work? Yes No
Desired Salary:



Work History
Please list your last five employers (most current first).
Company 1 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 
Company 2 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 
Company 3 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 
Company 4 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 
Company 5 Date From To
 
Address
City State Zip Telephone
 
Position Held Salary Number of Employees
 
Type of Industry 
Job Duties
 
Supervisor to Contact (for reference) Title
 
Reason for leaving

 

References
Please list references other than stated above that we have permission to contact.
Name Title Telephone Relationship


EEO Information
To assist in gathering statistical information required to demonstrate TAD PGS, Inc.'s compliance with Equal Employment Opportunity laws, please voluntarily complete this form. Neither the information contained in the form nor your decision not to fill out this form will be considered in arriving at a decision regarding your employment. This information will be filed separately from your employment application.

(I) Please check the race or ethnic group to which you belong:

(1) 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.
 
(2) 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.
 
(3) Black or African American (Not Hispanic or Latino)
    A person having origins in any of the black racial groups of Africa.
 
(4) Hispanic or Latino
    A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
 
(5) I choose not to self identify
 
(6) Native Hawaiian or Other Pacific Islander (Not Hispanic/Latino)
    A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
 
(7) Two or More Races (Not Hispanic or Latino)
    All persons who identify with more than one of the above five races.
 
(8) White (Not Hispanic or Latino)
    A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
 

(II) Please indicate if you belong to either of the two groups listed below:

Vietnam Veteran - (a) A person who served more than 180 days of active military, navy, or air service, any part of which was during the period of August 5, 1964 through May 7, 1975, and who (1) was discharged or released with other than a dishonorable discharge, or (2) was discharged or released from active duty because of a service-connected disability if any part of his or her active duty was between August 5, 1964 and May 7, 1975. (b) A person who served more than 180 days of active military, navy, or air service, who served within the Republic of Vietnam, any part of which was during the period of February 28, 1961 through May 7, 1975, and who (1) was discharged or released with other than a dishonorable discharge, or (2) was discharged or released from active duty because of a service- connected disability if any part of his or her active duty was between February 28, 1961 and May 7, 1975.
 
Other Protected Veteran - A veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.
 
Special Disabled Veteran - A veteran 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 Veterans Administration for a disability (1) rated at 30 percent or more, or (2) rated at 10 to 20 percent in the case of a veteran who has been determined under section 3106 of Title 38, U.S.C., to have a serious employment handicap or (B) a person who was discharged or released from active duty because of a service-connected disability.
 
Recently Separated Veteran - A veteran who served on active duty in the US military, ground, naval, or air service during a one-year period beginning on the date of a veteransí discharge or release from active duty.
  If recently seperated vet, please provide discharge date:  
 


Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:
  • Blindness
  • Autism
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • Deafness
  • Cerebral palsy
  • Major depression
  • Obsessive compulsive disorder
  • Cancer
  • HIV/AIDS
  • Multiple sclerosis (MS)
  • Impairments requiring the use of a wheelchair
  • Diabetes
  • Schizophrenia
  • Missing limbs or partially missing limbs
  • Intellectual disability (previously called mental retardation)
  • Epilepsy
  • Muscular dystrophy
Please check one of the boxes below:
YES, I HAVE A DISABILITY (or previously had a disability)
NO, I DON'T HAVE A DISABILITY
I DON'T WISH TO ANSWER

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Laborís Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

OMB Control Number 1250-0005
 


Gender: 

 
*Are you authorized to Work & Reside in the US; without a need for a visa sponsorship and/or transfer?:
  Yes   No  
 
Have you ever been convicted of a felony or misdemeanor? If you are in the state of Washington please limit your response to seven (7) years. If you are in the state of California, answer NO if the conviction is a MISDEMEANOR conviction relating to Marijuana and is more than two (2) years old or if you participated in any pre-trial or post-trial diversion programs. If you are in Washington D.C. please limit your response to (10) years. If you are in the State of Massachusetts, answer no if the conviction is a MISDEMEANOR conviction that: 1) is a sealed record, or 2) is a first conviction for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbances of the peace, or 3) where the date of conviction or the completion of any resulting incarceration is more than (5) years ago.:
  Yes   No  
 
The above question does not apply to convictions that have been expunged, sealed, pardoned, or otherwise exonerated or eradicated. You may answer "no" with respect to any inquiry relative to prior arrests that did not lead to a conviction. A conviction will not necessarily be a bar to employment, all circumstances will be considered. If "YES", please describe fully the criminal conviction(s), listing the nature and date of the offense(s) and your rehabilitation since the conviction(s)::
  *255 Max Characters
 
Are you working now?:
  Yes   No  
 
Are you open to contract work?:
  Yes   No  
 
Are you flexible to work overtime?:
  Yes   No  
 
What percentage of time are you available to travel (if required)?:
  *use CRTL key to select more than one
 
If necessary, are you willing to relocate at your own expense for the right opportunity?:
  Yes   No  
 
What is your requested salary range? Please put the lowest and the highest amount you are looking for so that we can see your range.:
    
 
How soon can you start if offered a position?:
   
 
Are you a military spouse?:
  Yes   No  


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