EMPLOYMENT APPLICATION

Employment Application

TIMAC does not discriminate in hiring or employment on the basis of race, color, religion, sex, age, national origin, veteran status, sexual orientation, gender identity, disability or any other basis of discrimination prohibited by law. No question on this application is intended to secure information to be used for such discrimination. In order to be considered an applicant, you must apply for one or more of those positions that are currently open and possess the minimum qualifications for the position(s).

Position(s) for which you are applying:

Type of employment desired:

Full Time Part Time

Indicate the number of hours you are available per week:

Date available to start:

Full Name

Address

City

State

Zip Code

Phone (Home)

Phone (Cell)

Have you ever filed an application with TIMAC before?

Have you ever been employed by TIMAC before?

*If yes, please give dates: (from/to)

Are you on a lay-off and subject to recall?

Have you ever been terminated from a position for poor performance or misconduct?

If yes, please explain:

High School or Prep School:

City & State

Major course of study:

Last year completed:

Degree or diploma:

College or Technical School:

City & State

Major course of study:

Last year completed:

Degree or diploma:

College (Advanced Degree):

City & State

Major course of study:

Last year completed:

Degree or diploma:

List particular skills you feel especially qualify you for the position you seek with this organization. Include, if applicable, specialized certifications or licenses, computer knowledge and experience level, language fluency, equipment operation, skilled trade knowledge, etc.):

Typing

Words per minute:

Dictation

Words per minute:

Computer Skills - Hardware Used:

Computer Skills - Software Used:

Computer Skill Level:

Company Name:

Address:

City:

State:

Zip Code:

Employed From (Mo./Yr.)

Employed To (Mo./Yr.)

Position Title:

Supervisor Name, Title (plus contact information:

Description of duties, responsibilities and/or significant accomplishments:

Hours Worked Weekly:

Reason for Leaving

Company Name:

Address:

City:

State:

Zip Code:

Employed From (Mo./Yr.)

Employed To (Mo./Yr.)

Position Title:

Supervisor Name, Title (plus contact information:

Description of duties, responsibilities and/or significant accomplishments:

Hours Worked Weekly:

Reason for Leaving

A minimum of 2 positive references from individuals other than friends or family members must be obtained. If your work history above is insufficient to provide 2 reference contacts, please provide additional references below (i.e. former or current teachers, professors, directors from organizations for which you have volunteered, etc.).

Name of Reference:

Position/Title & Where Employed:

Relationship to You (i.e. former teacher, etc.)

Phone Number:

Name of Reference:

Position/Title & Where Employed:

Relationship to You (i.e. former teacher, etc.)

Phone Number:

Name of Reference:

Position/Title & Where Employed:

Relationship to You (i.e. former teacher, etc.)

Phone Number:

Upload Resume:

I certify that the information contained on this application is correct to the best of my knowledge and understand that falsification of this information is grounds for dismissal if employed by TIMAC. I further understand that this application is not intended to be a contract of employment, nor does this application obligate TIMAC any way if it decides to employ me. I authorize the employers/supervisors listed above to give TIMAC any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing said information to the TIMAC.

Please identify any employers/supervisors you do NOT wish TIMAC to contact and reason not to contact:

TIMAC is hereby authorized to investigate my past employment, professional and other licensure and/or certifications, criminal record, child abuse record, driving record and military record through its management office or its designee. For the purpose of verifying my qualifications for employment, the TIMAC is authorized to obtain educational records and information relating to courses taken, my performance in those courses, degrees and awards received by me as well as disciplinary actions taken against me while enrolled. In the event an investigation reveals convictions or security related issues, I understand my employment, or consideration for employment, could be terminated immediately. I understand that passing a drug test is a condition of employment and, if an employment offer is extended, depending upon the requirements of the position for which I am being hired, I may be required to take, pass, and complete job-related physical examinations. No representative of the TIMAC other than the owner has any authorization to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. If employed by the TIMAC, I agree to conform to its policies and procedures and understand that employment at TIMAC is at will; i.e., either you or TIMAC may discontinue employment at any time, for any or no reason, with or without notice.

Please be advised that if selected for employment, you will be required to provide proof that you are legally eligible to be employed in the United States.

Please also be advised that if you are selected as a finalist for a position, part of the background check may include a criminal history check and/or child abuse clearance. Convictions are not an automatic disqualification to employment and all qualified applicants are encouraged to apply. The specific offense/criminal record is evaluated on an individual basis, which considers, at minimum, the essential functions and nature of the job and the seriousness/classification, circumstances, and age of the offense(s).