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Employment Application
Employment Application
Last Name
*
First Name
*
Middle Initial
Address
*
City
*
State
*
Zip Code
*
Contact Phone
*
Email Address
*
Position Applied For
*
Desired Wage
*
How were you referred to Elevate Recoveries?
*
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
If Yes, Please Explain
If selected for employment are you willing to submit to a pre-employment drug screening test?
*
Yes
No
Education
School Name
Location
Years Attended
Degree Received
Major
School Name
Location
Years Attended
Degree Received
Major
Other training, certifications or licenses held
Employment History
Present/Last Employer
Employer
Work Phone
Address
City
State
ZIP
Position
Starting Salary
Ending Salary
Date Employed From
Date Employed To
Duties Performed
Supervisor Name
Supervisor Title
Reason For Leaving
May We Contact Them?
Yes
No
Previous Employer 1
Employer
Work Phone
Address
City
State
ZIP
Position
Starting Salary
Ending Salary
Date Employed From
Date Employed To
Duties Performed
Supervisor Name
Supervisor Title
Reason For Leaving
May We Contact Them?
Yes
No
Previous Employer 2
Employer
Work Phone
Address
City
State
ZIP
Position
Starting Salary
Ending Salary
Date Employed From
Date Employed To
Duties Performed
Supervisor Name
Supervisor Title
Reason For Leaving
May We Contact Them?
Yes
No
References
First Reference
Name
Title
Company
Phone
Second Reference
Name
Title
Company
Phone
Third Reference
Name
Title
Company
Phone
Resume' (Optional)
Resume' File
Acknowledgment/Authorization
Required
*
I certify that all answers given herein are true and complete to the best of my knowledge.
authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.
Name
This field is for validation purposes and should be left unchanged.
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