Career Form

EMPLOYMENT APPLICATION

Please complete the entire application.

Note: It is the policy of Dazzle Reality, LLC to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

01. Applicant Information

Applicant Full Name:
Home Address:
City/State/ZIP:
Number of years at this address:
Daytime phone:
Evening phone:
Mobile phone:
Social Security Number:
Driver's License (State/Number):

02. Emergency Contact

Who should be contacted if you are involved in an emergency?
Contact Name:
Relationship to you:
Address:
City/State/ZIP:
Daytime phone:
Evening phone:

03. Job Positions

Job Position Applied For:
Full or Part Time?
Are you willing to work as an Independent contractor?
Per
Do you have any friends or relatives who work here? If yes, please list here:
06. Have you applied to our company previously?
YESNO
07. Are you at least 18 years old?
YESNO
08.If you are offered employment, when would you be available to begin work?
09.If hired, are you able to submit proof that you are legally eligible for employment in the United States?
YESNO
10.Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?
YESNO

What reasonable accommodation, if any, would you request?

11. Applicant's Skills

Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Ability or Skill Years of Experience Rating

Typing
Microsoft Office Suite (Word, Excel, etc
Answering telephones
Customer service
Sales/ Marketing


12. Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

Employment History (01)

Employer Name:
Supervisor Name:
Contact Information:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):

Employment History (02)

Employer Name:
Supervisor Name:
Contact Information:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):

Employment History (03)

Employer Name:
Supervisor Name:
Contact Information:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):

13. Applicant's Education and Training

College/University Name and Address
Did you receive a degree?
YESNO
High School/GED Name and Address
Did you receive a degree?
YESNO
Other Training (graduate, technical, vocational):
Please indicate any current professional licenses or certifications that you hold:
Awards, Honors, Special Achievements:
Military Service:
YESNO
Branch:
Specialized Training:

14. Applicant's Education and Training

List any two non-relatives who would be willing to provide a reference for you.

Name:
Address:
City/State/ZIP:
Telephone:
Relationship:
Name:
Address:
City/State/ZIP:
Telephone:
Relationship:
15. Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

CERTIFICATION

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
I authorize Dazzle Reality, LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.
If hired, I agree to go through a credit check, criminal record check and drug screening.
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
APPLICANT SIGNATURE
(Upload your Resume, Cover letter Or Certificates)

DATE