Employment Application

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Step 1 of 5

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Personal Information
Name*
FirstLast
Address*
Street AddressCityStateZip Code
Phone*
Email*
Position Desired & Past History
Position Desired*
Salary Requirements*
Have you ever been employed by Stevens?*
- Yes
- No
If yes, when?
Have you ever applied for employment with Stevens?*
- Yes
- No
If yes, when?
Referred by
Name of relative/partner employed by Stevens
Have you ever been known by or gone by any other names?*
- Yes
- No
If yes, list
Have you ever been convicted of a felony or misdemeanor (other than traffic tickets)?*
- Yes
- No
If yes, please explain below
Answering "yes" to this question does not automatically bar you from employment. Factors such as date, nature and seriousness of the offense will be taken into consideration.

Education
Please list High School, Trade Schools, Colleges and Universities you have attended.
School
Location
Major
Years
Please enter a value less than or equal to 10.
Degree
Need more spaces for more schools, check here.
- More school fields
School
Location
Major
Years
Please enter a value less than or equal to 10.
Degree
School
Location
Major
Years
Please enter a value less than or equal to 10.
Degree
Major accomplishments, awards or training pertinent to the position you are applying for:
Computer Skills
Please indicate your skill level in each of the following computer applications and list any other relevant applications
AS400*
Microsoft Word*
Microsoft Excel*
Microsoft PowerPoint*
Other
Skill Level

Employment History
Please list your positions and employers including U.S. Military, part-time, self employment and volunteer work. Please start with most recent. Note: All information including dates and salaries will be verified.
Employer 1
Employer
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Immediate Supervisor & Title
Date Employed

Specific dates are not necessary just month and year
Date Left
Salary Starting
Salary Final
Job Title
Job Responsibilities
Reason for Leaving
Employer 2
Employer
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Immediate Supervisor & Title
Date Employed

Specific dates are not necessary just month and year
Date Left
Salary Starting
Salary Final
Job Title
Job Responsibilities
Reason for Leaving
Employer 3
Employer
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Immediate Supervisor & Title
Date Employed

Specific dates are not necessary just month and year
Date Left
Salary Starting
Salary Final
Job Title
Job Responsibilities
Reason for Leaving

References
List the names and phone numbers of three (3) business references you have worked with. Please do not list names of relatives or partners. If you are not able to provide business references, list three school references that are not related to you.
Reference 1
Name*
FirstLast
Title*
Address*
Street AddressCityState / Province / RegionZip / Postal Code
Phone*
Email*
Company Name*
Connection / Relationship*
Years Known*
Please enter a value less than or equal to 80.
Reference 2
Name*
FirstLast
Title*
Address*
Street AddressCityState / Province / RegionZip / Postal Code
Phone*
Email*
Company Name*
Connection / Relationship*
Years Known*
Please enter a value less than or equal to 80.
Reference 3
Name*
FirstLast
Title*
Address*
Street AddressCityState / Province / RegionZip / Postal Code
Phone*
Email*
Company Name*
Connection / Relationship*
Years Known*
Please enter a value less than or equal to 80.

- I certify that all information and all documentation I have provided to Stevens in connection with my application and any potential employment is true, complete, accurate, authentic and correct. I understand that any information and documentation provided by me that is found to be false, incomplete or misrepresented in any manner or respect, will be sufficient cause to end any further consideration of my application or immediately terminate my employment, regardless of when it is discovered.
- I expressly authorize, without reservation, Stevens, its representatives, employees or agents to contact and obtain Information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, my resume or during any job interviews.
- I waive any and all rights and claims I may have against Stevens, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
- I hereby authorize any individual as well as the organization for which he or she acts, to provide information about me to Stevens.
- I hereby waive any rights and claims that I may have as a result of such disclosures by these individuals and organizations to Stevens.
- I understand that Stevens does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
- I understand this application remains current for only 60 days. At the conclusion of that time, if I have not heard from Stevens and still wish to be considered for employment, it may be necessary for me to reapply and fill out a new application.
- I understand that any employment with Stevens will be on an at-will basis, which means that my employment can be terminated with or without cause or notice.
- This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of Stevens is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing language are valid unless are in writing and signed by an officer of Stevens.
- Federal laws require that employers hire only individuals who are authorized to be lawfully employed by the United States. In compliance with such laws, it will be necessary for each employee to submit such documents as are required by law to verify identification and employment authorization.
- I understand and agree that any offer of employment I may receive from Stevens is contingent upon my successful completion of Stevens’ pre-employment screening process, including the receipt of references that are considered satisfactory and my satisfactory completion of any other pre-employment testing or examinations that Stevens may require.
- I also understand and agree that if employed, I may be required to submit to drug screening in accordance with the applicable law and company policies.
- I affirm that I have not signed any kind of restrictive document creating any obligation to any former employer that would restrict my acceptance of Employ- ment with Stevens.
I certify that I have read, full understand and accept all terms of the foregoing Applicant's Statement, Acknowledgement and Release
Signature*
This is an electronic signature. Please read the terms above and type your name to confirm.

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Employment Application

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Personal Information

Position Desired & Past History

Education

Computer Skills

Employment History

Employer 1

Employer 2

Employer 3

References

Reference 1

Reference 2

Reference 3

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