Client Name: ___________________________________
Client #/Div: _____________
Application for Employment
Please Answer All Questions. Resumes Are Not A Substitute For A Completed Application.
TO APPLICANT: We appreciate your interest in the Client employer and Modern Business Associates and
assure you that we are interested in your qualifications. A clear and full understanding of your background
and work history will aid us in placing you in a position that best meets your qualifications.
Applicants will be considered without discrimination because of race, color, sex, age, religion, national origin,
disability, veteran’s status, or any other category protected by applicable law. Client/MBA also provides reasonable
accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act
(ADA) and applicable state and local laws.
Position Applied for ___________________________________ Social Security Number _________________
Name ______________________________________________ Telephone Number (_____)_______________
Present Address (Street, Apt. or Unit No.) __________________________________________________________
City / State / Zip ___________________________________________ How Long Here? ______________
Are you legally eligible for employment in the United States? Yes No Desired Salary:_______________
Are you seeking Full or Part-time work? ________________________ What shift? _____________________
When are you available to begin work? ____________________________________________________________
Can you perform in a reasonable and safe manner the activities involved in the position for which you have
applied? Yes No
Have you ever been convicted of a crime other than a traffic offense, had adjudication of a crime withheld, pled nolo
contendere, or are currently being charged for a crime not yet adjudicated? Yes No
If Yes, state the nature of the offense and the date the event took place. (Answering yes will not necessarily be a
bar to employment. Each action/explanation will be weighed/considered in relationship to the position for which you
are applying.) ________________________________________________________________________________
___________________________________________________________________________________________
List your computer, foreign language skills and work experience which you feel qualifies you for the job for which
you are applying: ____________________________________________________________________________
___________________________________________________________________________________________
If a license is required for the position for which you are applying (driver’s or other), please list the following:
License Number: ______________________________________ State of Issuance: __________________
License Type: ____________________________________
# of
Education School Name and Location Course of Study Graduate? Degree/Diploma
years
High School
College
College
Bus./Tech./Trade
MBADVISORSID-
MBA_StandardApp.Rev.022015
LIST BELOW ALL PRESENT & PAST EMPLOYMENT BEGINNING WITH MOST RECENT
Name & Address of Company (Describe business type) Dates Employed:
______________________________________________ From ______________ To _________________
______________________________________________ Job Title ________________________________
Phone (________)_______________________________ Compensation:
Supervisor’s Name ______________________________ Start ______________ Last ________________
Reason Left_________________________________________________________________________________
Duties _____________________________________________________________________________________
Name & Address of Company (Describe business type) Dates Employed:
______________________________________________ From ______________ To _________________
______________________________________________ Job Title ________________________________
Phone (________)_______________________________ Compensation:
Supervisor’s Name ______________________________ Start ______________ Last ________________
Reason Left_________________________________________________________________________________
Duties _____________________________________________________________________________________
Name & Address of Company (Describe business type) Dates Employed:
______________________________________________ From ______________ To _________________
______________________________________________ Job Title ________________________________
Phone (________)_______________________________ Compensation:
Supervisor’s Name ______________________________ Start ______________ Last ________________
Reason Left_________________________________________________________________________________
Duties _____________________________________________________________________________________
I certify that all the information on this application, my resume, and all supporting documents is correct, and I understand
that any misrepresentation or omission of any information may result in disqualification from consideration for employment
or, if employed, my termination.
I understand that this application is not a contract, offer or promise of employment. If hired, I will be able to resign at any
time for any reason. Likewise, my employment can be terminated at any time, with or without any reason. I further
understand that if hired, my employment is at will.
I authorize Modern Business Associates or their agents to investigate all statements contained in this application and/or
resume. I further understand that a credit and background check may be made including, but not limited to, consumer
credit history, driving record, employment, military, education and general public records which will provide information
concerning my character, general reputation and mode of living. I hereby authorize my former employers, educational
institutions and individuals named to furnish all information pertaining to my work and educational record. I release my
former employers, educational institutions, supervisors, co-workers and references from all liability on account of
furnishing information to Modern Business Associates and their agents. I further release Modern Business Associates and
their agents from any liability as the result of such contacts and in connection with obtaining any credit and background
checks. Should a credit report be requested, I understand and agree that a separate authorization form will be utilized,
as required by law.
If required by law, a copy of this report will be provided to me. I hereby release from liability the employer and its
representative for seeking such information and all other persons, corporations or organizations for furnishing such
information.
I understand and agree that, as a condition of employment, I may be required to sign a non-compete agreement and/or a
conflict of interest statement.
I understand that Modern Business Associates may now have, or may establish, a drug-free workplace or a post-
accident drug-testing program. If either has one now or implements one in the future, and I am offered a conditional offer
of employment, I agree to work under the conditions requiring a drug-free workplace. I also understand and agree
that I may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the
presence of alcohol and/or drugs as a condition of continued at-will employment, and following any work-related
injury. I also agree to undergo random, fitness for duty, return to work, and reasonable suspicion alcohol and drug
testing. Refusal to take such tests when asked may result in termination.
I understand this company hires only U.S. citizens or individuals who are legally eligible to work in the United States.
This application is current for only sixty (60) days. At the conclusion of this time, if you have not heard from the Employer
and still wish to be considered for employment, it will be necessary for you to complete a new application.
Applicant Signature _____________________________________________ Date _______________________
MBADVISORSID-
Rev.022015