Mcss Ltd.

MCSS Ltd.

Application For Employment

Thank you for your interest in employment with MCSS Ltd. MCSS Ltd is an equal opportunity employer and will not discriminate against any employee or applicant on the basis of race, color, religion, sex, age, national origin, citizenship status, or disability. Questions on this application are not asked for the purpose of limiting or excluding any applicant's consideration for employment in any manner prohibited by law. We will review your credentials and contact those individuals who are most qualified for our current vacancies.

PERSONAL INFORMATION

*Required Information

First Name: *

MI:

Last Name: *

Address: *

City: *

State: *

Zip: *

Home/Other Phone: *

Work Phone:

Fax:

Mobile Phone:

Pager:

List any previous names which your records may be found(i.e.,maiden, married, etc).If this does not apply please enter NA: *

Transportation:

Public Own

Willing to travel?

Yes No

Willing to relocate? Where?

Best way to contact:

Best time to contact:

EDUCATION

	Name and Location of School	Course of Study/Major	Did you graduate?	No. of Years Completed	List Diploma or Degree
Grade/High School/GED			Yes
College/University			Yes
Graduate/Professional			Yes
Trade/Vocational/Other			Yes

If currently enrolled in school, list hours and days attending.

SKILLS / EXPERIENCE

Typing Speed-WMP:

Errors:

Software Packages:

MS Word MS Excel MS Access MS Power point

MS Outlook MS Publisher Peachtree Quick Books

Other Software Packages:

Office Equipment:

Other skills not mentioned above:

LICENSES

Professional Licensure

License/Certification	State/License No.	Date/Year Issued	Expiration Date	Temporary	Permanent

License(s) pending in (State/Country):

Has a State licensing authority ever revoked, suspended or placed conditions upon your professional license(s)

Yes No
If yes, please explain circumstances and outcome:

WORK HISTORY

List all pervious employment starting with your most recent position. Account for any time during this period that you were unemployed by stating the nature of activities in the box provided. Please indicate if you were employed under a different name.

Are you currently employed?

Yes No

1. Most recent employer

Name of Company:
Street Address:
City, State, Zip:
Employer's Phone:
Other Name(s) Used:
Job Title:
From(mo/yr):
To(mo/yr):
Salary:
Supervisor's Name:
Employment Status:		Full-time Part-time On call

Job Duties and Responsibilities:

Reason for Leaving:

May we contact this employer for a reference?
Yes No

Name of Company
Street Address:
City, State, Zip:
Employer's Phone:
Other Name(s) Used:
Job Title:
From(mo/yr):
To(mo/yr):
Salary:
Supervisor's Name:
Employment Status:		Full-time Part-time On call

Job Duties and Responsibilities:

Reason for Leaving:

May we contact this employer for a reference?
Yes No

Name of Company:
Street Address:
City, State, Zip:
Employer's Phone:
Other Name(s) Used:
Job Title:
From(mo/yr):
To(mo/yr):
Salary:
Supervisor's Name:
Employment Status:		Full-time Part-time On call

Job Duties and Responsibilities:

Reason for Leaving:

May we contact this employer for a reference?
Yes No

Name of Company:
Street Address:
City, State, Zip:
Employer's Phone:
Other Name(s) Used:
Job Title:
From(mo/yr):
To(mo/yr):
Salary:
Supervisor's Name:
Employment Status:		Full-time Part-time On call

Job Duties and Responsibilities:

Reason for Leaving:

May we contact this employer for a reference?
Yes No

State the nature of your activities during any period of time not worked:

Have you ever been discharged from job, or asked to resign?

Yes No

MILITARY SERVICE

Were / Are you a member of the U.S Armed Forces?

Yes No

Branch of service:

Area(s) of specialization:

Service or serial number:

ADDITIONAL INFORMATION

Interested in:

Regular hire Temporary Temp-to-hire

Hours available for work?

Full-time Part-time

Preferred shifts:

Geographic location:

What is your minimum salary requirement?

How did you find out about
MCSS Ltd?*

Please answer all of the following question.
* Yes No	Have you ever been convicted of a crime or received a verdict other than not guilty? If yes, describe when the conviction occured, location, facts and circumstances, and any facts pertaining to rehabilitation. (Do not list any criminal charges for which records have been expunged .A criminal offense will not necessarily bar employment.
* Yes No	The Immigration Reform and Control Act of 1986 states, offers of employment are conditioned upon satisfactory proof of identity and legal ability to work in the United States.If hired, can you furnish proof that you are legally permitted to work in the United States? You will be requested to submit two ID's.
* Yes No	Unless otherwise required by law, the minimum age for employment is 17 years. An offer of employment, if made will be subject to verification that applicant's age meets legal requirements. If necessary can you furnish proof of age if hired?
* Yes No	Please answer the following question ONLY after you have reviewed the major functions/requirements of the position(s) you are applying for. Can you perform the essential function of the position(s) that you are applying for with or without reasonable accommodation? Explain:

References:

List 3 references (no family, friends or relatives)Co-workers or supervisors preferred.

Name:

Phone:
This Format Please: 775-888-8888

Name:

Phone:
This Format Please: 775-888-8888

Name:

Phone:
This Format Please: 775-888-8888

Availability for an interview?

Days:

Morning:

Afternoon: