APPLICATION FOR EMPLOYMENT
 
 

BSC, Inc is committed to a policy of non-discrimination and Equal Opportunity for all employees and qualified applicants without regard to race, creed, color, religion, national origin, citizenship status, sex, sexual orientation, marital status, ancestry, age, disability, handicap, veteran status, or any other classification protected by applicable federal, state, or local laws.

 
PERSONAL INFORMATION
 
   
First Name Last Name MI
     
Address City State Zip
     
Home Phone Cell Phone Email Address
   
Are you lawfully authorized to work in the United States? yes no
Are you over 18 years of age? yes no
  (If not, employment is subject to verification that you are of minimum legal age and that you are able to supply any required work permit.)
If your educational or work records are listed under another name, please indicate the name(s)
What prompted you to apply to BSC, Inc.?
  If Other, please specify source:
Have you applied or interviewed at BSC, Inc. before? yes no If yes, when?  
Have you ever been employed by BSC, Inc. before? yes no If yes, when?  
               
   
       
EMPLOYMENT DESIRED
  
   
Position(s) applied for
   
Full time Part time    
Salary Expected
$
If offered a position, when are you available to start?
   
       
EDUCATION
  
   
Name Address
# Years attended
 Degree Major  
High School
   
College
Graduate School
Other
Please describe any other specialized training or skills that you may have (optional):
   
       
EMPLOYMENT HISTORY
  
   
Please provide a complete and consecutive record of your past and present employment, including any military service, listing your current or most recent employer first. You are welcome to include any verifiable volunteer work that you have performed.
Employer #1 Dates of Employment
           
Address City State Zip
   
Phone
             
May we contact? yes no
  Duties performed  
Supervisor's Name Hourly Rate/Salary
           
  Reason For Leaving  
Employer #2 Dates of Employment
           
Address City State Zip
   
Phone
             
May we contact? yes no
  Duties performed  
Supervisor's Name Hourly Rate/Salary
           
  Reason For Leaving  
Employer #3 Dates of Employment
           
Address City State Zip
   
Phone
             
May we contact? yes no
  Duties performed  
Supervisor's Name Hourly Rate/Salary
           
  Reason For Leaving  
Employer #4 Dates of Employment
           
Address City State Zip
   
Phone
             
May we contact? yes no
  Duties performed  
Supervisor's Name Hourly Rate/Salary
           
  Reason For Leaving  
Please list any special honors, awards, skills, or certifications that you feel would be beneficial to employment at BSC. You may include your affiliations in professional or civic associations (optional).
   
       
REFERENCES
  
   
Name Address
Telephone
#1
#2
#3
   
       
CONVICTIONS
  
   
 

AN APPLICANT FOR EMPLOYMENT WITH A DEALED RECORD ON FILE WITH THE COMMISSIONER OF PROBATION MAY ANSWER "NO RECORD" WITH RESPECT TO AN INQUIRY HEREIN RELATIVE TO PRIOR ARRESTS, CRIMINAL COURT APPEARANCES, OR CONVICTIONS. iN ADDITION, ANY APPLICANT FOR EMPLOYMENT MAY ANSWER "NO RECORD" WITH RESPECT TO ANY INQUIRY RELATIVE TO PRIOR ARESTS, COURT APPEARANCES AND ADJUDICATIONS IN ALL CASES OF DELINQUENCY OR AS A CHILD IN NEED OF SERVICES WHICH DID NOT RESULT IN A COMPLAINT TRANSFERRED TO THE SUPERIOR COURT FOR CRIMINAL PROSECUTION.

A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. THIS INFORMATION WILL BE USED ONLY FOR JOB-RELATED PURPOSES AND ONLY TO THE EXTENT PERMITTED BY APPLICABLE LAW.

Have you been convicted of a felony? yes no

If yes, please explain:

Have you been convicted or finished a period of incarceration within the past fice years for any misdemeanor (other than a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affrays or disturbance of the peace)? yes no

If yes, please explain:

If the answer to the previous question is "yes" please state whether you were convicted more than five years ago for any offense (other than a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affrays or disturbance of the peace)?

IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. ANY EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
   
       
PLEASE READ THE FOLLOWING CAREFULLY
  
   
 

I certify that this application was completed by me and the answers to the foregoing questions are true and correct to the best of my knowledge. I understand that any false statement, misrepresentation, or omission of fact will be deemed sufficient reason for rejection or termination of my employment, irrespective of time lapsed before discovery.

I give BSC, Inc. and its agents permission to investigate my background to ascertain any and all information of concern to this application, whether the same is of record or not, and I hereby release any current or former employers and any persons named herein from all liability for any damages on account of furnishing such information.

I acknowledge that any offer of employment by BSC, Inc. is conditioned upon verification of my identity and eligibility to work in the United States.

I acknowledge that, after acceptance of any offer of employment by BSC, Inc., BSC, Inc. will take my fingerprints and send them to the Federal Bureau of Investigation to ensure compliance with certain legislation of the Federal Deposit Insurance Act.

I understand that employment with BSC, Inc. is at-will and that neither this application, nor any other personnel form or policy constitutes an employment contract or agreement to hire me for a stated time or duration.

I understand that if I am hired by BSC, Inc., my employment is at-will, for no definite term, and that I can be terminated at any time without notive and without cause. I further understand that no verbal promises or guarantees are binding on BSC, Inc. and that no one, other than the President of BSC, Inc., has the authority to enter into an agreement for employment contrary to the above, and that any such agreement must be in writing to be enforceable.

I hereby acknowledge that I have read and understand the preceding statement.