Konop Companies
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Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodations to the application and/or interview process should notify a representative of the Human Resources Department.

Position(s) applied for Date of application
Referral
Source
Advertisement Employee Relative Government Employee Agency
Walk-in Private Employment Agency other
Name of source (if applicable)
Name: First Last Middle
Address       Social Security#
Telephone Mobile/Beeper/Other Phone Email address    
If necessary, the best time to call you at home is:
May we contact you at work?
If yes, work number and best time to call
PH# Time
If you are under 18 and it is required, can you furnish a work permit?
If not, please explain
Have you submitted an application here before?
If yes, give date(s) and position(s)
Have you ever been employed here before?
If yes, give date(s)
From To
Are you legally eligible for employment in this country?
Date available for work
 What is your desired salary range?
$
Type of employment desired
Full Time Part Time Temporary
Seasonal Educational Co-Op         
Will you relocate if job requires it?
 Will you travel if job requires it?
Are you able to meet the attendance requirements of the position?
Will you work overtime if required?
If not, please explain
Have you ever been bonded?*
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?*
If yes, please provide date(s) and details*
*Answering yes to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account
Driver's license number if driving is an essential job function
State

Employment History
Provide the following information of your past and current employers, assignments or volunteer activities, starting with the most recent. Explain any gaps in employment in comments section below.
EMPLOYER
TELEPHONE
DATES EMPLOYED
SUMMARIZE THE TYPE OF WORK PEFORMED AND THE JOB RESPONSIBILITIES
FROM
TO
ADDRESS
STARTING JOB TITLE / FINAL JOB TITLE
HOURLY RATE/SALARY
START
$
PER
IMMEDIATE SUPERVISOR AND TITLE
REASON FOR LEAVING
HOURLY RATE/SALARY
END
$
PER
MAY WE CONTACT FOR REFERENCE?

EMPLOYER
TELEPHONE
DATES EMPLOYED
SUMMARIZE THE TYPE OF WORK PEFORMED AND THE JOB RESPONSIBILITIES
FROM
TO
ADDRESS
STARTING JOB TITLE / FINAL JOB TITLE
HOURLY RATE/SALARY
START
$
PER
IMMEDIATE SUPERVISOR AND TITLE
REASON FOR LEAVING
HOURLY RATE/SALARY
END
$
PER
MAY WE CONTACT FOR REFERENCE?

EMPLOYER
TELEPHONE
DATES EMPLOYED
SUMMARIZE THE TYPE OF WORK PEFORMED AND THE JOB RESPONSIBILITIES
FROM
TO
ADDRESS
STARTING JOB TITLE / FINAL JOB TITLE
HOURLY RATE/SALARY
START
$
PER
IMMEDIATE SUPERVISOR AND TITLE
REASON FOR LEAVING
HOURLY RATE/SALARY
END
$
PER
MAY WE CONTACT FOR REFERENCE?

EMPLOYER
TELEPHONE
DATES EMPLOYED
SUMMARIZE THE TYPE OF WORK PEFORMED AND THE JOB RESPONSIBILITIES
FROM
TO
ADDRESS
STARTING JOB TITLE / FINAL JOB TITLE
HOURLY RATE/SALARY
START
$
PER
IMMEDIATE SUPERVISOR AND TITLE
REASON FOR LEAVING
HOURLY RATE/SALARY
END
$
PER
MAY WE CONTACT FOR REFERENCE?


Comments INCLUDING EXPLANATION OF ANY GAPS IN EMPLOYMENT
Skills and Qualifications
Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Education Background
A. List last three schools attended, starting with most recent. B. list number of years completed. C. Indicate degree or diploma earned, if any. D. Grade point average or Class Rank. E. Major field of study. F. Minor field of study (if applicable)
A. SCHOOL
B. NUMBER OF YEARS
COMPLETED
C. DEGREE
DIPLOMA
D. GPA CLASS RANK
E. MAJOR
F. MINOR

References
List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
NAME
TELEPHONE
NO. OF YEARS KNOWN

Additional Information
List professional, trade, business or civic associations and any offices held.
EXCLUDE MEMBERSHIPS THAT WOULD REVEAL, RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, CITIZENSHIP, AGE, MENTAL OR PHYSICAL DISABILITIES, VETERAN/RESERVE, NATIONAL GUARD, OR ANY OTHER SIMILIARLY PROTECTED STATUS.
ORGANIZATION
OFFICES HELD
List special accomplishments, publications, awards, etc...
EXCLUDE MEMBERSHIPS THAT WOULD REVEAL, RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, CITIZENSHIP, AGE, MENTAL OR PHYSICAL DISABILITIES, VETERAN/RESERVE, NATIONAL GUARD, OR ANY OTHER SIMILIARLY PROTECTED STATUS.
List any additional information you would like us to consider:

EMPLOYMENT APPLICATION DISCLOSURE STATEMENT


The Konop Companies disclosed to you that a consumer report, including a criminal background check, may be obtained for employment purposes as part of the pre-employment background investigations, and may be updated from time to time during your employment.

The Konop Companies disclosed to you that a pre-placement physical, which may include drug screening, may be requested for employment purposes as part of the pre-employment procedure, and may be updated from time to time during your employment.

EMPLOYMENT APPLICATION AUTHORIZATION STATEMENT


This shall authorize the procurement of a consumer report by The Konop Companies as part of the pre-employment background investigation. If hired, this authorization shall remain on file and shall serve as an ongoing authorization for The Konop Companies to procure consumer reports at any time during my employment period.

In connection with this request, I authorize all corporations, companies, former employers, supervisors, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts, motor vehicle bureaus, military services and persons to release information they may have about me to The Konop Companies, or its agent, and release all parties involved from any liability and responsibility for doing so.

I also authorize the procurement of any investigative consumer report and understand that it may contain information about my background, credit, mode of living, character, and personal reputation. This authorization in original or copy form shall be valid for this and any future reports or updates that may be requested.

I understand that I have the right to request additional disclosure as to the nature and scope of the investigation, upon written request, within a reasonable period of time.

APPLICATION STATEMENT

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

i expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this online application. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and that no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if i have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

if I am hired, i understand that i am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period of definite duration. I understand that no supervisor or representative is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration law requires me to complete an I-9 Form in this regard.

DO NOT SUBMIT THIS APPLICATION UNTIL YOU HAVE READ THE ABOVE STATEMENTS.
I certify that I have read, fully understand and accept all terms of the foregoing Application Statements.