El Teatro

Employment Application
DIRECTIONS: 1. Please complete all four pages (even if résumé is enclosed).
2. Please print.
3. This application will be considered active for a maximum of 90 days from the date of your on-line application. If you wish to be
considered for employment after that time, you must reapply.

PERSONAL DATA
LAST NAME

FIRST

STREET ADDRESS

COUNTY

TELEPHONE NUMBERDAYTIME TELEPHONE NUMBER

(

(

)

Yes

No From:

Yes

MIDDLE

No

)

CITY

STATE

ARE YOU AT LEAST 18 YEARS OLD

Yes

ZIP

ARE YOU ELIGIBLE TO WORK IN THE U.S.

No

Yes

No

EMAIL ADDRESS

HAVE YOU SERVED IN THE U.S. ARMED FORCES

HAVE YOU EVER BEEN CONVICTED OF A CRIME
OR PLEADED NOLO CONTENDERE

RANK AT DISCHARGE

LENGTH OF MILITARY SERVICE

//

To:

/

/
WHEN

IF YES, EXPLAIN

WHAT WAS THE OUTCOME (EXPLAIN FULLY)

NOTE: A conviction will not necessarily result in disqualification. The nature and recency of the offense and rehabilitation efforts will be considered.
HAVE YOU EVER BEEN PLACED ON PROBATION OR
TERMINATED FOR POOR JOB PERFORMANCE

Yes

HAVE YOU EVER BEEN DISCIPLINED OR DISCHARGED FOR VIOLATION
OF ACOMPANY POLICY

No
No

Yes

No

Yes
Yes

No

Yes

HAVE YOU EVER BEEN DISCIPLINED OR TERMINATED FOR
ABSENTEEISM, TARDINESS, FAILURE TO NOTIFY YOUR COMPANY
WHEN ABSENT, OR ANY OTHER ATTENDANCE-RELATED REASON
HAVE YOU EVER BEEN DISCIPLINED OR DISCHARGED FOR
BEING UNDER THE INFLUENCE OF ALCOHOL OR DRUGS, OR FOR
POSSESSION, USE OR ABUSE OF ALCOHOL OR DRUGS

No

No

Yes

YesHAVE YOU EVER BEEN DISCIPLINED OR FIRED FOR FIGHTING,
ASSAULT, OR SIMILAR OFFENSE

HAVE YOU EVER BEEN DISCIPLINED OR FIRED FOR
INSUBORDINATION

No

EMPLOYMENT GOAL
MINIMUM SALARY REQUIRED ARE YOU WILLING TO WORK ON SHIFTS OTHER THAN DAY SHIFT

POSITION APPLIED FOR

$
ARE YOU INTERESTED IN FULL-TIME OR PART-TIME EMPLOYMENT

DATE OF AVAILABILITY

IF PART-TIME, WHAT HOURSPart-Time
Full-Time

/

/

REFERRAL AND APPLICATION HISTORY
HAVE YOU EVER BEEN EMPLOYED BY ASSURANT OR ANY
OF ITS OTHER COMPANIES
HAVE YOU EVER APPLIED WITH ASSURANT BEFORE OR
ANY OF ITS OTHER COMPANIES
WERE YOU REFERRED BY AN ASSURANT OR ONE OF ITS
OTHER COMPANIES’ EMPLOYEES
DO YOU HAVE ANY RELATIVES WHO ARE PRESENTLY (OR HAVE
FORMERLY BEEN) EMPLOYED BY ASSURANT OR ONE OF
ITS OTHERCOMPANIES
IF NO, HOW WERE YOU REFERRED TO ASSURANT

Ad

Agency/Recruiter

Yes

No

IF YES, IN WHAT DEPARTMENT AND FOR WHEN DID YOU WORK FOR THE COMPANY
WHICH COMPANY

From:

IF YES, WHEN

Yes

To:

/

/

No

Yes

/

No

Yes

/

No

IF YES, PLEASE INDICATE WHO

IF YES, PLEASE INDICATE WHO

Open House/Career Fair

Website

Internet:_____________

Other(specify):_____________

As a part of our normal procedure for processing applications, a routine inquiry will be made concerning information on your employment and education
history. Depending on the position being applied for, an inquiry regarding your credit history may also be made. In compliance with the Fair Credit Reporting
Act, further information on the nature and scope of suchinquiry is available to you upon written request.
The Immigration Reform and Control Act of 1986 makes it a violation for an Employer to hire an individual without following certain verification and recordkeeping requirements. Employers must verify an employee’s identity and work authorization when hired; all employees must produce documents that will
establish their identity and employmentauthorization.
We are an equal opportunity employer that will not discriminate or tolerate discrimination against any employee or applicant in any manner prohibited by law.

A4646-0209

EMPLOYMENT HISTORY
DIRECTIONS: 1. This section must be completed in its entirety (even if résumé is enclosed).
2. Please list ALL employment, including temporary or part-time jobs held while in school or...