Legacy Jobsite

EMPLOYMENT APPLICATION

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Name of the person who referred you (if applicable):

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Position Desired:

Personal

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First Name Middle

Last Name

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Email:

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Phone: (xxx-xxx-xxxx)

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Other: (xxx-xxx-xxxx)

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Address:

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City: • State:

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Zip:

Previous Addresses (for at least the last (5) years)

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Address:

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City: • State:

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Zip:

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Address:

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City: • State:

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Zip:

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Address:

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City: • State:

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Zip:

BACKGROUND

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Are you at least 18 yrs old? YES NO
If not are you at least 16 yrs? YES NO

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Do you have a work certificate (from school)? YES NO

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Have you been convicted of a crime? YES NO

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If you answered yes to the above question, please explain:

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Have you ever been disciplined, suspended, discharged, or asked to resign from a job in connection with a loss of money, merchandise, or equipment?
YES NO

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If you answered yes to the above question, please explain:

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Have you ever been disciplined or discharged for absenteeism or tardiness? YES NO

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If you answered yes to the above question, please explain:

EMPLOYMENT

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Have you ever applied for work at this company or any of its subsidiaries? YES NO

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If you answered yes to the above question, when:

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Are you currently employed? YES NO

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Do you need to give 2 weeks notice? YES NO

We need to know about your last five (5) years of employment.
If you have never been employed, please write the names of non-relatives
who may be contacted for reference. You may include any verified volunteer work.

Current or Last Employer:

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Company:

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Address:

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Phone (xxx-xxx-xxxx):

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Supervisor's Name:

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Supervisor's Title:

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Position:

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Dates Worked: From To

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Rate of Pay:

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Reason for leaving:

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May we contact this employer? YES NO

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If not please state why:

Previous Employer (1):

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Company:

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Address:

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Phone (xxx-xxx-xxxx):

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Supervisor's Name:

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Supervisor's Title:

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Position:

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Dates Worked: From To

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Rate of Pay:

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Reason for leaving:

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May we contact this employer? YES NO

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If not please state why:

Previous Employer (2):

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Company:

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Address:

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Phone (xxx-xxx-xxxx):

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Supervisor's Name:

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Supervisor's Title:

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Position:

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Dates Worked: From To

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Rate of Pay:

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Reason for leaving:

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May we contact this employer? YES NO

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If not please state why:

Previous Employer (3):

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Company:

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Address:

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Phone (xxx-xxx-xxxx):

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Supervisor's Name:

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Supervisor's Title:

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Position:

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Dates Worked: From To

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Rate of Pay:

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Reason for leaving:

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May we contact this employer? YES NO

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If not please state why:

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Please list any products or services you have sold previously:

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Please list any call center experience not listed in previous employers section:

Educational Background:

High School:

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Name:

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Address:

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Graduated? YES NO

College:

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Name:

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Address:

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Course or Major:

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Graduated? YES NO

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Degree:

Other Education:

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Name:

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Address:

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Course or Major:

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Graduated? YES NO

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Degree:

REFERENCES:

Give below the names of three persons not related to you whom you have known at least one year.

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Name:

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Address:

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Years Known:

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Phone: (xxx-xxx-xxxx)

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Business Phone: (xxx-xxx-xxxx)

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Name:

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Address:

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Years Known:

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Phone: (xxx-xxx-xxxx)

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Business Phone: (xxx-xxx-xxxx)

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Name:

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Address:

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Years Known:

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Phone: (xxx-xxx-xxxx)

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Business Phone: (xxx-xxx-xxxx)

Upload Your Cover Letter/Resume

To upload your files, select the "Browse" button below, then use the choose file window to identify your cover letter/resume on your hard drive. Select your document and hit the "Open" button. Your document file name will then be displayed in the appropriate field below.

**Please note that your cover letter/resume must be in either MS Word (.doc) or text (.txt) format. If you wish to keep your contact information confidential, you must remove all contact information from your files before you upload it.

Upload Your Cover Letter

Upload Your Resume

Please read the following information carefully and acknowledge by selecting YES at the bottom

An Equal Opportunity Employer

In compliance with Federal and State equal employment opportunity laws, all qualified candidates will be considered for employment without regard to their race, creed, color, national origin, ancestry, sex, age, marital status, veteran status, or the presence of non-job related medical conditions or disabilities.

Applicant's Certification and Agreement

• The distribution or receiving of this application by the Company does not imply or intend to imply an agreement or contract to employ the applicant. The purpose of this application is solely to allow persons a standardized form on which to submit their qualifications. This application will be considered valid for no longer than three months. Re-application is necessary after three months.
• I authorize all persons, schools, employers, and organizations mentioned in this application to provide the Company with any and all information requested by the Company, and I voluntarily release such persons, schools, employers, and organizations from all liability for providing such information.
• In the event I am employed by the Company, I agree to comply with all its rules, regulations and directives. I understand that my employment is for no stated term and is subject to termination at the will of the Company.
• I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would affect this application unfavorably. I understand that falsification, misrepresentation, or omission of facts called for in this application may result in denial of employment or immediate dismissal. I herby acknowledge that I have read, understand, and consent to the above statements.
• I also understand that if offered employment, I must prove my identity and my eligibility to work in the United States, prior to being employed.
• I certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with Legacy Publishing Company and for no other reason.

I have fully read and understand the above:

Legacy Publishing Company
INITIAL SCHEDULE AVAILABILITY COMMITMENT
Hours of Operation: 5 am to midnight, 7 days a week

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Name:

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Date: Full Time Part Time

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Number of hours you would like to be scheduled each week:

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Number of days you would like to be scheduled:

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Maximum length of each shift: hours

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Minimum length of each shift: hours

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Are you available to work on weekends? Yes No

We require all new hires to work at least one night shift
(4 hours after 5pm) and a Saturday or Sunday shift.

Day	Hours Available	Hours Preferred
MONDAY	to	to
TUESDAY	to	to
WEDNESDAY	to	to
THURSDAY	to	to
FRIDAY	to	to
SATURDAY	to	to
SUNDAY	to	to

Legacy Publishing Company will make every effort possible to schedule you within your preferred hours but cannot guarantee that you will only be scheduled within them. Agent agrees to the above schedule commitment for a minimum of 90 days, unless there are extreme extenuating circumstances. Requests for any change must be made in writing at least two weeks in advance. No schedule change will be effective until signed and returned by the Director of Sales. By selecting YES below, I am committing to be available at the times listed above. I understand I will be notified of my schedule at the end of each week for the following week.

I commit to be available at the times listed above: