: ISA Online Application :

ISA Online Application:
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APPLICATION FOR EMPLOYMENT

INSERVICE AMERICA is an Equal Opportunity Employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability or veteran status. The use of this form does not mean there are positions open and does not obligate us in any way.

ADVANCE REQUEST FOR REASONABLE ACCOMODATION

We encourage qualified individuals with disabilities to apply for employment. Individuals with disabilities who require reasonable accommodation to participate in any portion of the application, interview and/or testing components of the hiring process must advise us in advance. Upon request, applicants must provide documentation confirming a disability and the need for accommodation.

This is an important document. Please complete all requested information accurately and completely.

If you have a resume, please attach it here.
First Name: *
Last Name: *
Address: *

City: *
State: *
Zip: *
Phone Number: *
Cell Number:
E-mail Address: *
Best Time to Reach You: *
Morning Afternoon Evening Night
Are you at least 18 years of age? *	Yes No
Are you a U.S. citizen or an alien authorized to work in the U.S.? *	Yes No
How did you find out about employment opportunities with INSERVICE AMERICA? *
Are you able to perform the essential functions of the job, with or without reasonable accommodation, for which you are applying?	Yes No
Have you ever applied for employment with INSERVICE AMERICA? If Yes, when? *
Have you ever worked for INSERVICE AMERICA? If Yes, When? *
If Yes, was your termination: *	Voluntary Involuntary I have never worked for ISA
Name of your last Supervisor at INSERVICE AMERICA:
Please list exact reason(s) for leaving our company:
Position Held:
Do you have any relatives currently employed with INSERVICE AMERICA? if Yes, name & relationship please. *
Highest Level of Education: *
Primary School High School Diploma Some College Bachelors Degree Graduate / Masters Degree
If you earned a college degree, please list the major:
Position Applying For: *
Type of Employment: *	Full-time Part-time Project / Seasonal / Temp Remote Home Agent
Are you employed now? *	Yes No
Shift Preferred?	First Second Third Any
Salary Desired: *
Available Start Date: *
Due to the nature of our business, most schedules require Sunday availability. Will you be available to work on Sunday? *	Yes No
Will you be able to work overtime if needed? *	Yes No
If hired, can you be flexible to work in departments other than the one you were specifically hired for? *	Yes No
Have you ever been convicted of a crime other than a minor traffic violation? (Conviction is not necessarily an absolute barrier to employment) If yes, please describe: *
If applying for a position in the Distribution Center (warehouse), are you able to lift on a continual basis	Light (0-20 lbs) Medium (20-50 lbs) Heavy (50+ lbs)
Please list all equipment that you have operated which would be useful in the positions for which you have applied: *
Please list all computer software applications and types of computers that you have experience operating: *
Previous Employer #1:
Dates Employed:
Supervisor Name:
Phone:
Job Duties at Previous Employer:

Previous Employer #2:
Dates Employed:
Supervisor Name:
Phone:
Job Duties at Previous Employer:

Please list any other job related skills:
Additional Information:

Please list three professional references: *
Social Security Number *
Before you submit this form, please rean the AUTHORIZATION (below) carefully! *	Yes, I read the Authorization and verify all information is correct. Yes, I read the Authorization but can not verify all information is correct.


* Required

AUTHORIZATION: Please read.
1. I hereby declare the information provided by me in this application is true and complete, and I understand that falsification of this information is grounds for refusal to hire, or if hired, termination at any time, and I waive all rights to bring any action for defamation, intrusion of privacy or any other similar cause of action against anyone contacted.
2. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability for any damage which may result from furnishing such information to you.
3. I authorize INSERVICE AMERICA to request, receive and verify all information given in this application.
4. In consideration for my employment by INSERVICE AMERICA, I agree to abide by the rules and Policies of the company set forth in the Associate Handbook, including but not limited to the Alternative Dispute Resolution Policy ("ADR"), the Substance Abuse Policy, and the Anti-Harassment Policy and acknowledge that these rules and Policies may be changed, interpreted, withdrawn or added to by INSERVICE AMERICA at any time, without any prior notice to me. I understand that the ADR Policy provision providing for final and binding arbitration also applies to covered claims (as defined therein) arising out of my candidacy for employment and application for employment, even if I am not hired by INSERVICE AMERICA.
5. I further acknowledge that if I am employed by INSERVICE AMERICA, or a subsidiary company, my employment will be "at will" and may be terminated with or without cause at any time by me or by INSERVICE AMERICA, or a subsidiary company even after I have completed my introductory period.
6. I understand that no representative of the company has any authority to enter into any agreement for any specified period of time or to assure any benefits or terms and conditions of employment, either prior to commencement of employment or after I have become employed. Please consult the Associate Handbook for benefits, policies and rules.
7. I consent to a physical examination, which includes a drug test, after I have become employed, as deemed necessary by INSERVICE AMERICA.. I understand that any offer of employment is contingent upon my passing a drug test and any other required physical examinations.
8. I understand that by signing this application for employment, I may be required to submit to a police background check. I hereby release, acquit, covenant not to sue and forever discharge all persons and entities, including, without limitation, INSERVICE AMERICA and all of its officers, directors, employees, agents, attorneys, shareholders, heirs, assigns, successors, trustees, parents, subsidiaries, operating divisions and affiliated entities from all causes of action, claims, suits, and/or liabilities arising out of or related in any way to any background investigation, to the request for consent to any background investigation and/or to the request for or disclosure of information made pursuant to any background investigation.