SIRS, Inc. Employment Application

Position Applied For

Location Location Tell City (Perry/Spencer) Jasper (Dubois) Evansville (Warrick/Vanderburgh) All (for Regional openings)

Full Name

Address

City

State

Zip Code

Contact Number

Email

How did you hear about us? How did you hear about us? Newspaper Ad Employment Agency Current Employee TV SIRS Website Monster.com Indeed.com Facebook Other

Are you legally eligible to work in the United States? Are you legally eligible to work in the United States? YES NO

Are you over the age of 18 years? Are you over the age of 18 years? YES NO

Have you ever been convicted of a felony? Have you ever been convicted of a felony? YES NO

If convicted of a felony, please explain

Do you have a valid driver license? Do you have a valid driver license? YES NO

Is anyone related to you employed by SIRS? Is anyone related to you employed by SIRS? YES NO

If related to a SIRS employee, give their name and relationship

Have you ever been fired or asked to resign? Have you ever been fired or asked to resign? YES NO

If fired or asked to resign, please explain

If offered a job, on what date would you be available to start work?

Are you willing to work nights, weekends, and/or holidays if needed? Are you willing to work nights, weekends, and/or holidays if needed? YES NO

What is the highest level of education you have received? What is the highest level of education you have received?High SchoolSome CollegeAssociates DegreeB.S./B.A. DegreeMasters DegreeOther

Have you received any job-related training in the United States Military? Have you received any job-related training in the United States Military? YES NO

Military training dates and explanation (enter N/A if none)

Employment History - Company Name

Employment History - Employment Dates

Employment History - Name & Title of Supervisor

Employment History - Address

Employment History - Phone

Employment History - Describe Your Duties

Employment History - Reason For Leaving

Reference 1 - Name

Reference 1 - Phone

Reference 2 - Name

Reference 2 - Phone

Reference 3 - Name

Reference 3 - Phone