NCC Application Form

Application for Employment

We are an equal opportunity company dedicated to a policy of nondiscrimination in employment on any basis, including race, color, age, sex, religion, national origin, citizenship status, disability, marital status, and any classification protected under applicable law, the use of any information on this application will be consistent with the company's policy to provide equal treatment for all.

Please complete the following application and submit:

Last Name:*		First Name:*		M.I.:
Street Address:*		City:*		State:*	:Zip Code:*
Telephone No.:		SSN:
Email:*
Positions applied for:*
	Have you ever worked for us before?	Yes	No
If Yes, when?		Reason for leaving:
	Do you speak another language fluently?	Yes	No
If Yes, what language?
	Do you know anyone who works for our company?	Yes	No	If Yes, who?
	Were you ever convicted of a crime?	Yes	No
If Yes, please explain

***In evaluating applicants, we consider such factors as how long it has been since the offense occurred, seriousness and nature of the violation; rehabilitation will also be taken into account.***

EDUCATION

Type of School	Name	Course of Study	Years Completed	Did you graduate?	Dates Attended
Elementary
High School
College
Business/Trade

WORK HISTORY

List below all present and past employment, beginning with the most recent.

Employer Name	From	To	Position	Start Salary	End Salary	Reason for Leaving	Supervisor Name/Phone
				$	$
				$	$
				$	$
				$	$

REFERENCES

Give names, addresses, and occupations of three persons who have known you for the past five years or longer. Do not give names of relatives or former employees.

Name	Address/Phone	Occupation

The facts set forth in this application are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. By submitting this application, I hereby authorize NCC to make any investigation of my personal history and financial credit record through any investigation or credit agencies of bureaus of their choice.