The Clinton Group- Online Application

Fields in Yellow must be completed.

First Name
Last Name/M.I.

Social Security #

Address

City/State/Zip

Telephone/Emergency
phone number

How long have you lived at this address?

Previous Address

Type of work preferred?

Are you willing to work

Would you accept another position?

yes no

Do you have telemarketing experience?

yes no

Are you 18 years or older?

yes no

Over 40 hours/week?

yes no

Nights?

yes no

Weekends?

yes no

Education

School

City/State

Major

Degree

Years Attended

HIGH SCHOOL (OR HIGHEST GRADE COMPLETED)

COLLEGE OR UNIVERSITY

OTHER (GRADUATE, TRADE, VOCATIONAL)

Work History

ORGANIZATION AND JOB TITLE	LOCATION AND DATE OF EMPLOYMENT	REASON FOR LEAVING AND SUPERVISOR	PHONE NUMBER AND RATE OF PAY

Are you legally eligible for employment in the U.S.?

yes no

Have you ever worked for this company?

yes no

When?
Reason for Leaving?

Have you ever been convicted of a crime?

yes no

Describe

Military Service

Branch/Rank at discharge

From/To


MOS/Duties

I certify that the information in this application is correct to the best of my knowledge and understand that deliberate falsification is grounds for dismissal in accordance with this company's policy. I authorize the references listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing the same to you. I will acknowledge that if I become employed, I will be free to resign at any time for any reason, and this company similarly retains the right to terminate my employment at will. EOE.

* E-MAIL ADDRESS (Acts as temporary signature and MUST be valid.) / Date