Application for Employment

Please begin your application by filling out all relevant fields in the form below.

Name:
Other Names:
Email Address:
Home Address:
Telephone Number(s):
SS Number:
Position Applied For:
Date of Application:

How did you hear about FST&N?
Fleschnerlaw.com Local Newspaper Staffing Agency
Other Please Specify:
Current Employee

Are you available to work:
Regular Full-time:
Regular Part-time Hours:
Temporary Hours:
Date Available:
Salary Desired:

Are you over 18 years old? Yes No
Are you legally eligable to work in the United States?
(Proof of citizenship or immigration status will be required upon employment)		 Yes No
Have you even submitted an application to FST&N before?
If yes, please give date: 		Yes No
Have you ever been employed with FST&N before?
If yes, please give date: 		Yes No
Do you have any relatives working at FST&N?
If so, who? 		Yes No
Has FST&N ever represented or apposed you in any legal matter?
If yes, please give case name and date: 		Yes No
Have you ever been convicted of a felony?
If yes, explain:
 Yes No
Are you currently employed? Yes No
May we contact your present employer for references? Yes No

Education High School Technical School College Post Graduate
School Name/Location
Years Completed
Diploma Degree
G.P.A.
Major Course(s) of Study

Employment Experience (Attach additional sheets if necessary)
Start with your most recent position. If information is already on your resume, fill in only those items not listed on your resume (i.e. reason for leaving, salary, etc.)

Experience 1

Employer:
 Dates Employed:
May We Contact:
Address:
 From:
 To:
Telephone Number(s): Base Pay:
Job Title:

Supervisor:
 Start Pay:
 Final Pay:
Reason for Leaving:
Work Performed:

Experience 2

Employer:
 Dates Employed:
May We Contact:
Address:
 From:
 To:
Telephone Number(s): Base Pay:
Job Title:

Supervisor:
 Start Pay:
 Final Pay:
Reason for Leaving:
Work Performed:

Experience 3

Employer:
 Dates Employed:
May We Contact:
Address:
 From:
 To:
Telephone Number(s): Base Pay:
Job Title:

Supervisor:
 Start Pay:
 Final Pay:
Reason for Leaving:
Work Performed:

Applicant Acknowledgement and Authorization

*Please read carefully before signing*

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Fleschner, Stark, Tanoos & Newlin (hereinafter referred to as "FST&N") that such employment with FST&N is at will, for no specified duration and may be terminated by either FST&N or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of FST&N or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of FST&N except the Executive Director has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the Executive Director of FST&N.

In consideration for employment with FST&N, if employed, I agree to conform to the rules, regulations, policies and procedures of FST&N at all times.

In connection with my application for employment and / or continued employment, I hereby authorize FST&N and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and /or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand the scope of the consumer report / investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including records from any criminal justice agency in any or all federal, state, or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

I authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish FST&N with any and all information in their possession regarding me in connection with an application for employment.

I am authorizing a photocopy of this authorization be accepted with the same authority as the original.

I understand that this application is considered current for three months. If I wish to be considered for employment after this period I must fill out and submit a new application.

By entering my name and date below I acknowledge that I have read, understood, and agree to the above statements.

* Signature (Name) Date

* = Required

FST&N is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, gender, national origin, age, disability, veteran status, or any other status protected by law.