gilmore-research.com

The Gilmore Research Group

Online Employment Application


2101 4th Avenue Suite 800
Seattle, WA 98121
(Phone) 206-726-5555      (Fax) 206-726-5620
New Employee Application Form

INFORMATION

LAST NAME: FIRST NAME: MIDDLE IN:
PRESENT ADDRESS: CITY: STATE: ZIP:
HOME OR MESSAGE PHONE: WORK: E-MAIL:
POSITION APPLIED FOR:              Telephone Interviewer     Focus RecruiterDATE AVAILABLE FOR WORK:
AVAILABLE:Monday 4pm - 9pmTuesday 4pm - 9pmWednesday 4pm - 9pm 
Thursday 4pm - 9pmFriday 4pm - 9pmSaturday 9am - 4pmSunday 1pm - 8pm
Will visa or immigration status prevent lawful employment?            Yes     No
(proof of right to work in the U.S. will be required if hired.)
Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodation?
Yes  No
Are you 18 years or older?            Yes     No                      (if no, employment is subject to minimum legal age requirements.)
Have you been convicted of a felony or released from prison within the past 10 years?
(A conviction may not necessarily disqualify you from employment.)
Yes     No     If yes, please indicate the date and nature of the offense:
Do you have a Non-Compete, Non-Disclosure, or other agreement that might restrict your employment with us?         Yes     No
Have you ever previously applied to or been employed by this company?           Yes     No
if yes, when?
How did you learn about this position opening?
Were you known by any other name at any job or school listed on this application?
Which school(s)/employer(s) were you known by this other name?

EDUCATION

 Name and Location of SchoolYears CompletedDid you graduate?Degrees Received
High School
College
trade,
Business, or
Graduate School

SKILLS

Second Language(s):    Typing:wpm    Ten-key    Bookkeeping
Receptionist #incoming lines   Supervision (yrs of experience)Other
Proficient at: Excel   Word   Access   PowerPoint   Outlook
Other computer skills/experience
Indicate other skills related to the position you are seeking

EMPLOYMENT RECORD

(INCOMPLETE APPLICATIONS CANNOT BE ACCEPTED)
Please list your employment history below beginning with the most recent employer, including U.S. military service.
If currently employed, may we contact your employer?YesNo
Employer Occupation/Job Telephone
City State Fax
Job Title Supervisor Telephone
Dates Employed:
From To 		Reason for leaving Wage/Salary
Duties
Employer Occupation/Job Telephone
City State Fax
Job Title Supervisor Telephone
Dates Employed:
From To 		Reason for leaving Wage/Salary
Duties
Employer Occupation/Job Telephone
City State Fax
Job Title Supervisor Telephone
Dates Employed:
From To 		Reason for leaving Wage/Salary
Duties

REFERENCES

Give Below The Names If Three Persons Not Related To You Whom You Have Known At Least One Year.
NamePhone NumberBusinessYears Acquainted
1.
2.
3.

By submitting this application I certify that the information given by me is true and complete to the best of my knowledge. I understand that if I am employed, the discovery that I gave false information during the application process may result in immediate dismissal.

I authorize the Company to which I am providing this application (Gilmore Research) to investigate all statements contained in this application and to request information about me from previous employers, educational institutions, and references. I expressly authorize my previous employers to provide information and opinions concerning my work and habits. Further, I release all parties (Gilmore Research) and persons connected with any requests for information from all claims, liabilities, and damages for whatever reason, arising out of furnishing any information. If employed, I release the Company from any liability for future references it may provide reguarding my work history with the company.

Due to the large number of applications that Gilmore Research recieves, I understand Gilmore Research cannot guarntee that my application will be considered for any or all open positions they or the Company may have or that my application will be considered for any specific time.

In the event of employment, I understand that I am required to abide by all the current and subsequently issued rules and regulations of the Company and that my employment and compensation may be terminated, at any time, with or without notice, by either party.

Gilmore Research is an equal opportunity employer.

 
 
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