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eCommerce Consortium- Application Form
If interested in employment at eCommerce Consortium please complete the application form and paste a copy of your resume in the space provided. Please do not attach your resume to the completed application form. Thank you for your cooperation.
Date   (MM/DD/YY)  Full Time     Part Time     Per Diem
Temporary Permanent
Position Applying For
(Please enter position title)
Salary Desired
Name
Address
City
State
Zip Code
Phone No. (home)
Phone No. (business)
Email Address
Social Security No.
Shift: Day     Evening     Night     Weekends     Holidays     Flex


Through what source are you applying for employment? (check one and name the source)
Newspaper Ad
Employment Agency
Referred by 
Other (Explain)


What type of transportation would you use to get to work?
Car
Bus

Other (Explain)


Please give employment record as completely as possible. For any unemployed or self employed periods, please show dates. Start with your present or last employer.
Name and Address of Employer
Date Mo/Yr. Rate of Pay Position Held and Name of Immediate Supervisor Reason for Leaving
Name
From
Starting
Position
Address
To
Final
Supervisor
         
Name
From
Starting
Position
Address
To
Final
Supervisor
         
Name
From
Starting
Position
Address
To
Final
Supervisor


Have you ever worked at eCommerce Consortium before? Yes     No

If Yes: When     Where

Name while employed at eCommerce Consortium


Do you have any relatives working here?


  Who?        Relationship?        Department?


Veteran of U.S. Armed Forces?     Yes     No
Branch
  Serial No.
Reserve Status
  Draft Status
Date Entered
  Date Discharged
Rank at Discharge

     
Have you ever been refused bond?

Yes     No  
 
     If Yes, explain
Have you ever been convicted of a crime?

Yes     No   

     If Yes, explain
Schools Name and Adress of Institution Dates (optional) Graduated
From To
Mo/Yr Mo/Yr Yes No
Grade School
High School
College
Trade
Other

 

Special Skills:

Typing     W.P.M
Steno      W.P.M
Other 

Language: other than English   Yes    No

Spanish
French
Other

If applying for an other professional position, please answer the following:
Shift Preferred     7A-3P 7A-7:30P 3P-11P
7P-7:30A 11P-7A Other
Staff     Part Time     Per Diem
Shift Assigned
N.Y. Registration No.     Other States in which registered
Certificate No.     Registration No.
If not registered in N.Y., have you written for application? Yes     No
If Yes, when     If no, why not



List two persons who are to be notified in case of an emergency:

  Name Address Phone No.
1
2


Are you legally eligible to work in the U.S.A per the Immigration Reform & Control Act?
Yes     No
Paste resume here.
IN ORDER TO BE EMPLOYED, YOU MUST SUPPLY THE APPROPRIATE VERIFICATION OF YOUR EMPLOYMENT, REGARDLESS OF YOUR PLACE OF BIRTH.

The above answers are correct and complete. By submitting this application, I further authorize eCommerce Consortium  to contact my past employers. My present employer may may not be contacted. I understand employment is conditioned upon receipt of satisfactory references and any FALSIFICATION WILL LEAD TO IMMEDIATE DISCHARGE. I further understand I must satisfactorily pass a physical examination and be photographed as a condition of employment. I further understand that if employed I agree to be available, at the discretion of the company, to work on a shift other than that for which I am employed.

 

 

 


 

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