Employment Application Form

Application For Employment

Applicants are considered for all positions without regard to race, color, religion, gender,
national origin, ancestry, age, disability, marital or veteran status, sexual orientation,
or other status as protected by law.

(* indicates required field)

	APPLICANT INFORMATION
	Position Applying For:*
	Referral Source:*
	If Referral is selected, please give name
	Name:*(enter your full name)
	Address:*
	City:*
	State:*
	Zip:*
	Telephone:*
	Email Adress:*
	Confirm Email Adress:*
	Please list all addresses below where you resided in the last 7 years:
	Old Address 1:
	Old Address 2:
	Old Address 3:
	If you are under 18, can you furnish a work permit if hired?*	yes no
	Have you filed an application here before?*	yes no
	Have you ever been employed here before?*	yes no
	If yes, please give date:
	Are you currently employed?*	yes no
	May we contact your present employer?*	yes no
	If hired, can you provide proof that you are eligible to work in the U.S.?*	yes no
	(Proof of citizenship or immigration status is required upon employment)
	On what date would you be available for work?*
	Which of the following can you work?*(you can check more than one) Full Time Part Time Shift Work Temporary
	Are you on a lay-off and subject to recall?*	yes no
	Can you travel if a job requires it?*	yes no
	Please list any languages other than English that you can communicate in:
	REFERENCES
	Please give the name, address and telephone number of three references:*
	Reference 1:*
	Reference 2:*
	Reference 3:*
	EMPLOYMENT EXPERIENCE
	Start with your present or most recent job: Exclude organizations that indicate race, religion, gender, or national origin:
	Employer:
	Phone#:
	Job Title:
	Supervisor:
	Dates Employed:
	Salary:
	Work Performed:
	Reason For Leaving:

	Employer:
	Phone#:
	Job Title:
	Supervisor:
	Dates Employed:
	Salary:
	Work Performed:
	Reason For Leaving:

	Employer:
	Phone#:
	Job Title:
	Supervisor:
	Dates Employed:
	Salary:
	Work Performed:
	Reason For Leaving:
	EDUCATION INFORMATION
	*High School*
	High School Name:
	Years Completed:
	Did you receive a diploma?	yes no
	*College*
	College Name:
	Years Completed:
	Course of Study:
	Honors Received:
	Did you receive a degree?	yes no
	State any additional information you would like us to consider regarding your application:
	APPLICANT'S STATEMENT
	I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may disqualify me from further employment and may be justification for my dismissal from employment, if hired. I understand, also, that I am required to abide by all rules and regulations of Monarch Recovery Management, Inc. I understand that this application does not by itself, create or imply a contract of employment. I understand and agree that if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time. I understand that no person is authorized to change any of the terms mentioned in this employment application.
	I have read and agree to the above terms

	NOTIFICATION AND AUTHORIZATION FORM FOR DRUG SCREENING AND FINGERPRINTING
	I understand that Monarch Recovery Management may require me to submit to a drug screen and/or fingerprinting as a condition of employment. I understand that the drug screen will be conducted by a qualified drug screening company that will test for the presence of illegal substances. I understand that the fingerprinting will be done by qualified personnel pursuant to client guidelines and/or business requirements and will be used for criminal background check purposes. I agree to submit to a drug screen and/or fingerprinting, if so directed by Monarch. I authorize appropriate persons within Monarch's Management and Human Resources Department to receive and review the results of my drug screen and/or fingerprinting. I further authorize Monarch to disclose the results of my drug screen and/or fingerprinting to an authorized representative of a Monarch client for whom I perform collection services upon appropriate request of that client representative. I acknowledge that Monarch reserves the right not to offer me employment and/or terminate my employment if my screen produces a drug-positive result. I further acknowledge that Monarch reserves the right not to offer me employment and/or terminate my employment if my fingerprinting results show disqualifying offenses.
	I have read and agree to the above terms

MONARCH RECOVERY MANAGEMENT, INC. | 10965 DECATUR RD | PHILADELPHIA, PA 19154 | PHONE 215.281.7500 | FAX 215.281.7512