The Conti Group - Application for Employment

We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

* indicates a required field

* Applicant name:
* Position(s) applied for / type of work desired:
* Address:
* Phone:
Email:
* Employment Type Desired:
* Date you will be available to start work:
* Do you have any objection to working overtime if necessary?:
* Can you travel if required by this position?:
* Have you ever been previously employed by our organization?:
* Can you submit proof of legal employment authorization and identity?:
* If you are under 18, can you furnish a work permit if it is required?:
* Have you ever been convicted of a crime in the last 7 years?:	If yes, please explain (a conviction will not automatically bar employment):
Driver's license number (if driving is an essential job duty):
* How were you referred to us?:
* Skills and Qualifications:	Summarize any job-related training, skills, licenses, certificates, and/or other qualifications:
* Educational History:	List school name and location, years completed, course of study, and any degrees earned (High School, College, Technical Training, etc.):
* References:	List 3 references' names, telephone numbers, and years known (do not include relatives):

Employment History:
Please provide all employment information for your past four employers starting with the most recent.

* Employer:
* Position held:
* Address:
* Phone:
* Immediate supervisor and title:
* Dates employed:	from to
Salary:
* Job summary:
* Reason for leaving:

Employer:
Position held:
Address:
Phone:
Immediate supervisor and title:
Dates employed:	from to
Salary:
Job summary:
Reason for leaving:

Employer:
Position held:
Address:
Phone:
Immediate supervisor and title:
Dates employed:	from to
Salary:
Job summary:
Reason for leaving:

Employer:
Position held:
Address:
Phone:
Immediate supervisor and title:
Dates employed:	from to
Salary:
Job summary:
Reason for leaving:

Affirmative Action Program

Conti has an Affirmative Action Program and will make available such elements of this program as will enable employees to know and avail themselves of its benefits.
Submission of the information requested below is completely voluntary and for statistical purposes only. The information will be treated as confidential and neither the information nor the refusal to provide it will be used in any way in the selection process. It will be used only in administering our Affirmative Action Programs and for periodic reporting as required by the federal and state governments.

Gender:
Race/ Ethnicity:	White (A person having origins of the original peoples of Europe, North Africa or the Middle East) Black or African American (A person having origins in any of the Black racial groups of Africa) Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race) Asian (A person having origins in any of the original people of the Far East, South East Asia, or the Indian Subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam) American Indian or Alaskan Native (A person having origins in any of the original peoples of North America and South America including Central America and who maintains tribal affiliation or community attachment) Native Hawaiian or other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands) Two or More Races (All persons who identify with more than one of the above six races)
Military Status:	Special Disabled Veteran (i) a veteran of the US military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans� Affairs of Disability (A) rated at 30% or more, or (B) rated at 10% or 20% in the case of a Veteran who has been determined under Section 38U.S.C. 3106 to have a serious employment handicap or (ii) a person who was discharged or released for active duty because of a service connected disability. Vietnam Era Veteran A person who (i) served on active duty in the US military, ground, naval or air service for a period of more than 180 days, who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975, and all other cases; or (ii) was discharged or released from active duty in the US military, ground, naval or air service for a service connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964 and May 7, 1975 in any other location. Newly Separated Veteran Veterans who served on active duty in the US military, ground, naval or air service during the one year period beginning on the date of such veteran�s discharge or release from active duty. Other Eligible Veteran Veterans who served on active duty in the US military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized. Non Veteran

By submitting this application to The Conti Group, you agree to the following:
I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I understand that a background investigation may be required in addition to the reference checks and if required I will provide the information necessary and sign the authorized release form. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

As a condition of employment, all new employees will agree to enter the company's Arbitration Agreement, a program which is subject to a separate written agreement. This agreement allows for a quick resolution to employee/employer grievances by arbitration as opposed to jury trial. The procedure will follow the "Labor Arbitration Rules" as established by the American Arbitration Association.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

Current resume:	(required)
NOTE: In order to be considered for a position, a resume must be attached as part of the submission. Please note that the submitted resume cannot be a scanned version, and should be a Microsoft Word (.doc), Adobe PDF (.pdf) or plain ASCII text (.txt) document.