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Employment Application

(* required field)

I. Personal Information

Application for position @ location:
Last Name *
First Name *
Middle Initial
Current Street Address *
City *
State *
Zip Code *
Permanent Address (if different from above)
Telephone Number * (xxx-xxx-xxxx)
Alternate Telephone Number (xxx-xxx-xxxx)
E-Mail Address *

Are you 16 years of age or older? * If No, how old?
Have you ever worked for or applied to work for this company before? * If Yes, when?
Are you fluently (conversationally) bilingual in English and Spanish? *

Availability: Please tell us which hours you are available for work:

Total weekly hours desired? *
Do you have transportation to work? *
How did you hear about this job?
If you were referred by a current VuPoint Research employee, please enter their name:
Are you legally able to work in the USA? *
Salary Desired:

II. Work Experience

Company Name Position Held Dates of Employment Direct Supervisor Reason for Leaving

III. Education

Highest grade completed:
Graduated from:
Graduation Date:

IV. Employment, Professional, or Personal References

Name Address Telephone Years Known Relationship

V. US Military

Branch of service:
Highest Rank:
Do you have service-related skills and experience applicable to civilian employment?

In exchange for the consideration of my job application by VuPoint Research, Inc. (hereinafter called “the company”), I agree that:

Neither the acceptance of this application not the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like, as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of VuPoint Research, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President of the company. Both the undersigned and VuPoint Research, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I understand that, in connection with the routine processing of your employment application, the company may request from a consumer reporting agency, an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the company will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

* I certify that I have read and fully completed all pages of this application and that the information contained on this application is correct to the best of my knowledge and understand that any omission or erroneous information is grounds for dismissal as per VuPoint Research, Inc.’s policy. I authorize investigation of all statements contained in this application. I hereby give the company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the company from any liability as a result of such contract.

*VuPoint Research is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, veteran status or disability. We assure you that your opportunity for employment with this company depends solely on your qualifications.