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Candidate Information
First Name
Middle Name
Last Name
Previous name(s)/aliases if different than current
Address
International
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
Email Address
Are you 18 years or older?
Yes
No
Are you authorized to work the US?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Are you presently being charged with a felony?
Yes
No
Answering Yes will
NOT
automatically disqualify you from employment.
ConvictionExplaination
POSITION DESIRED
Position applying for
Desired Start Date
Salary Desired
What shifts are you available for?
1st
2nd
3rd
What shift(s) is most preferred?
What is you desired status?
Full Time
Part Time
Seasonal
Have you ever been employed with our company before?
Yes
No
If yes, what location?
Date
Do you have family/friends employed with our company?
Yes
No
if so, who?
Do you require any accommodations in order to perform the essential functions of the job?
Yes
No
If so, what accommodations do you require?
Do you have any activities, commitments, or responsibilities (for example, school, other employment, etc.) that might interfere with your ability to work your schedule, including overtime?
Yes
No
If so, explain below:
EDUCATION
High School Name
Highest Grade Completed
Diploma/GED Received
Yes
No
College Name
How many years
Degree/Certificate received
Yes
No
List any special trades, skills, or certifications
Employment History
Job 1
Employer Name
Phone Number
City
State
Job Title
Dates of Employment
to
Reason for Leaving
Supervisor Name
Supervisor Contact Information
Salary/Wage
Is this a present employer?
Yes
No
If so, may we contact your employer?
Yes
No
Job 2
Employer Name
Phone Number
City
State
Job Title
Dates of Employment
to
Reason for Leaving
Supervisor Name
Supervisor Contact Information
Salary/Wage
Is this a present employer?
Yes
No
If so, may we contact your employer?
Yes
No
Job 3
Employer Name
Phone Number
City
State
Job Title
Dates of Employment
to
Reason for Leaving
Supervisor Name
Supervisor Contact Information
Salary/Wage
Is this a present employer?
Yes
No
If so, may we contact your employer?
Yes
No
Emergency Contacts
Contact 1
Full Name
Phone
Email
Relationship
Contact 2
Full Name
Phone
Email
Relationship
Background Check
The following infomation is optional to provide. A background check is required for employement at Blu Perspective and providing the information now will help expedite the employement process.
I agree to a background check
Birth Date
SSN
Driver License Number
I certify that all information contained in this application is true and made in good faith. I agree and understand any falsifications, omissions, misstatements, or misrepresentations above will result in my forfeiting any rights of consideration for employment, or if hired, could lead to my dismissal. Under the Michigan Persons with Disabilities Civil Rights Act, a person with a disability may allege a violation of the Act regarding the failure to accommodate only if the person with a disability notifies the employer in writing of the need for accommodation within 182 days after the date the person with a disability knew or reasonably should have known an accommodation was needed. This does not preclude my rights under federal law which establishes a 300 day status of limitation. I further acknowledge that the employer enforces a drug-free workplace. By submission of this application, I am authorizing Blu Perspective and any of its affiliates to conduct a criminal history, background check, drug screen and to contact past employers regarding references as part of the pre-employment process.
Name:
Signature:
By checking this Electronic Signature Acknowledgment Checkbox, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.
I agree to these terms
