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 Coures 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 PowerPoint
    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
     
2.    
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
     
3.    
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
     
4.    
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 speciality:  
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
MCCS 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 rehabilltation. (Do not list any criminal charges for which records have been expunged.A criminal offense will not necessarity 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.
     
Availability for an interview?
     
Days:  
Morning:  
Afternoon: