Application For Employment

AN EQUAL OPPORTUNITY EMPLOYER

Please read before filling out this application

Please provide complete and legible information. An incomplete application may affect your consideration for employment. If necessary, attach a separate sheet for additional information.WestBridge Vocational (WBV) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin or ancestry, sex, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, marital status, or any other legally recognized protected basis under federal, state, or local law. The information collected by this application is solely to determine suitability for employment, verify identity, and maintain employment statistics on applicants.

Applicants with disabilities may be entitled to reasonable accommodation under the Americans with Disabilities Act and certain state or local laws. Reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on WBV. Please inform the company’s personnel representative if you need help completing this application or to otherwise participate in the application process.

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General Information

Last Name *

First Name *

Middle Initial

Street Address *

Address Line 2

City *

State *

Postal / Zip Code *

Contact Number *

Email Address *

Are you legally authorized to work in the United States? *

Yes

Do you now, or in the future, require immigration sponsorship for work authorization (e.g. H-1B)? *

If hired, verification will be required consistent with federal law.

Yes

Are you 18 years or older? *

If no, you may be required to provide authorization to work.

Yes

Position Information

Position Applied For: *

Rate of Pay Expected: *

How did you learn about the position? *

Friend

Walk-In

Relative

Other

Please tell us how did you learn about the position:

Applying for: *

Full-Time

Part-Time

Have you ever applied to, or worked for WBV before? *

Yes

If yes, When? *

Education

High School *

Location *

Major Subject or Course of Study *

Did you Graduate? *

Yes

College *

Location *

Major Subject or Course of Study *

Did you Graduate? *

Yes

Business or Trade School

Location

Major Subject or Course of Study

Did you Graduate?

Yes

Background Information

Have you ever been discharged, suspended, or asked to resign from any position? *

Yes

If yes, please explain: *

For the purpose of verifying information on this application, have you ever worked or attended school under a different name at any of the organizations you have listed? *

Yes

If yes, specify name: *

Have you ever been convicted of a crime, other than a minor traffic violation, that has not been expunged, sealed, pardoned, annulled, statutorily eradicated, or dismissed upon condition of probation? You are not required to disclose sealed or expunged records of conviction or arrest or expunged juvenile records of conviction or arrest. *

Yes

If yes, please explain: *

Note: Answering “Yes” does not necessarily preclude you from employment as we perform individualized assessments for all applicants. Have you signed or otherwise agreed to any non-solicitation, non-competition, or other similar post-employment restriction or agreement with your current or prior employer? *

Yes

If yes, explain: *

Employment Record

List all employment experience starting with the most recent or present employer, including US military service or training. Resumes may not be substituted in lieu of completing the following employment information.

From

Company Name:

Telephone

Street Address

Address Line 2

City

State

Postal / Zip Code

Starting Salary:

Final Salary:

Supervisor's Name/Title:

Type of Business:

Your Position/Title:

Your Responsibilities:

Is this your current employer

Yes

Specific Reason for leaving:

May we contact?

Yes

If no, Why?

From

Company Name:

Telephone

Street Address

Address Line 2

City

State

Postal / Zip Code

Starting Salary:

Final Salary:

Supervisor's Name/Title:

Type of Business:

Your Position/Title:

Your Responsibilities:

Is this your current employer

Yes

Specific Reason for leaving:

May we contact?

Yes

If no, Why?

From

Company Name:

Telephone

Street Address

Address Line 2

City

State

Postal / Zip Code

Starting Salary:

Final Salary:

Type of Business:

Supervisor's Name/Title:

Your Position/Title:

Your Responsibilities:

Is this your current employer

Yes

Specific Reason for leaving:

May we contact?

Yes

If no, Why?

Relatives In Our Employment

Do you have any relatives working with us? *

Yes

Mention their names with the relationship next to each name *

Personal/Professional References

List three (personal/professional) references (other than those listed as a current/former supervisor) that we may contact:

Reference 1:

Name *

Type of Acquaintance *

Years Known *

Phone *

Email *

Reference 2:

Name *

Type of Acquaintance *

Years Known *

Phone *

Email *

Reference 3:

Name *

Type of Acquaintance *

Years Known *

Phone *

Email *

Please Read Carefully Each Statement Before Signing:

1- I understand, where permissible under applicable federal, state, or local law, I may be subject to a pre-employment drug test after receiving a conditional offer of employment and must receive a negative result for illegal drug use before being permitted to commence work with WestBridge Vocational.

2- I understand, where permissible under applicable federal, state, or local law, I may be subject to a pre-employment medical examination after receiving a conditional offer of employment and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with WestBridge Vocational.

3- I understand, where permissible under applicable federal, state, or local law, I may be subject to a pre-employment background check after receiving a conditional offer of employment to investigate my criminal background, driving record, and other matters related to my suitability for employment. The offer is contingent upon the successful completion and outcome of the background check. I understand that a separate disclosure and consent form will be provided to me prior to any background check.

4- I understand employment with WestBridge Vocational is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.

5- I authorize WestBridge Vocational and its representatives to contact my current and former employers (with the exception of my current employer, if I have marked “May we contact?” as “No”), schools, references, and other persons or organizations I have named in this application for the purpose of verifying the information I have provided. I release my current and former employers, schools, references, and other persons or organizations named in this application from any liability resulting from the information released. I authorize employers, schools, and other persons or organizations named in this application to provide any information or transcripts requested.

6- I hereby certify that, if employed, my employment with WestBridge Vocational will not conflict with, violate, breach, or result in default under, any contract, agreement, or understanding that I am a party to or am bound by, including any non-solicitation, non-competition, or other similar post-employment restriction or agreement I have with any current or former employer, other than the contracts, agreements, covenants, or understandings I have disclosed in this application, if any.

7- I understand and agree that, if hired, my employment will be “at-will”, which means employment is for an indefinite period of time and may be terminated by myself or WestBridge Vocational at any time, with or without cause, and with or without notice.

8- I certify that all of the above information is true and complete, and I understand that any falsification or omission of information made by me may disqualify me from further consideration for employment or, if hired, may result in my termination at any time during the period of my employment, regardless of the amount of time that has passed.

MY SIGNATURE IS EVIDENCE THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.

Applicant's Signature: *

Application For Employment

Please read before filling out this application

General Information

Position Information

Education

Background Information

Employment Record

Relatives In Our Employment

Personal/Professional References

Reference 1:

Reference 2:

Reference 3:

Please Read Carefully Each Statement Before Signing:

Contact Us

Location

Hours

Phone