Employment Application New Employment Application Personal Information Name * First Last * Last Home Phone Mobile Phone Email * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Are you 18 years or older? YesNo Can you show proof of authorization to work in the United States? YesNo Have you ever been convicted of a felony that has NOT been legally expunged? YesNo Employment Desired Full-TimePart-TimePart-Time or Full-Time Position Desired: Pay Desired: Date you would be available to start: Referred by: All information provided on this Application for Employment is true, correct, and complete to the best of my knowledge. Unless otherwise indicated above. I authorize NineStar Connect and its agents to contact my present and former employers and investigate all the information contained in this application for employment. I hereby release and forever discharge all persons or companies, and their agents and managerial employees, from any and all claims, know or unknown, on account of or arising out of the disclosure and collection of the requested information concerning my employment. I understand that if I have made a false statement on this Application and NineStar Connect discovers that false statement after employing me, I may be subject to immediate dismissal. I understand that this Application will be considered active for ninety (90) days following submission. I further understand that if NineStar Connect does not act favorably upon this Application within that time period, it will be necessary for me to renew my interest by completing another Application of Employment. Any applicant receiving an offer of employment will be required to submit to a pre-employment drug and alcohol test. Our company uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify Pre-Employment Inquiry Release In conformance with the Fair Credit Reporting Act and other state or federal law regulation, I, the undersigned, hereby consent and authorize the Company, its affiliated companies, its subcontractors and/or its agents (collectively referred to as “the Company”) to obtain consumer/investigative consumer reports on me including, but not limited to information concerning my character and general reputation through a consumer reporting agency of its choice in connection with my employment. These reports may be obtained through, but not limited to the following sources: motor vehicle reports, social security number verification, present and former addresses, criminal and civil history/records, credit history, education, work habits, performance, reasons for termination of past employment from previous employers and any other federal and state non-public records concerning my past activities. The Company will evaluate the findings of the report(s) in terms of the business necessities of the position and/or their relatedness to the duties of the position. I hereby authorize without reservation, any party or agency contracted by this employer to furnish the above-mentioned information. If an adverse employment decision is made due, in whole or in part, to the information contained on the consumer/investigative consumer report, the Company will provide me with a copy of the consumer/investigative consumer report, a summary of my rights under the Fair Credit Reporting Act, and the course of the consumer/investigative consumer report so that I may contact them, if I wish to do so. I agree that the Company may use such consumer/investigative consumer reports for any and all employment purposes. I agree that this authorization shall remain in effect unless and until revoked in writing by me. First Name MI Last Name Other/Former Names Social Security Number Date of Birth Driver’s License Number Name as it appears on Driver’s License Signature signature keyboard Clear Date Submit If you are human, leave this field blank.
