We consider applicants for all positions without regard to race, color, religion, gender, sexual orientation, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.

*Required Fields

Position (s) Applied For:

Phone Interviewing	Supervisor
Face-to-face	Petition circulator
Administrative Assistant

How did you learn about us?

News story
Classified ad -> Which Paper?
Friend/Relative
BRC Interviewer -> Who?
Walking by
Other

Personal Data

Last Name:
First Name:	Middle Name:

Address:    Number / Street:
City:	State:	Zip Code:
	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Telephone Number:

E-Mail Address:

 

Are you at least 18 years of age? Yes   No

If not, are you at least 16? Yes   No

Do you have a valid AZ drivers license?

Yes

No

Have you ever filed an application with us before?

Yes	If yes, dates:
No

Have you ever been employed with us before?

Yes	If yes, dates:
No

Are you a U.S. citizen?

Yes

No

If "NO", can you provide proof of eligibility to work in the U.S.?

Yes

No

Have you been convicted of a felony within the last 7 years?

Yes ->  Please explain:
No

Education / Special Skills

Some interviewing requires the ability to perform some of the following tasks. Are you able to perform the following without difficulty.

	Yes	No
Read and write English
Read and write Spanish
Sit for extended periods of time
Speak clearly
Work outdoors
Stand for extended periods of time

Please indicate your experience in each of the following areas:

	Yes	No
Telephone Interviewing
In-Person Interviewing
Focus Group Recruiting
Petition Signature Gathering
Telemarketing
Product Demonstrations
Mystery Shops

Typing skills

WPM:

What is the highest level of education you have completed:

Still in High School
High School Grad/GED
Some College
College Degree

Describe any specialized training, apprenticeship, skills and extra-curricular activities

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, sexual orientation, national origin, handicap or other protected status.

Current Employer:
Address:
Telephone Number:
Job Title:	Supervisor:
May we contact your present employer?
Yes   No
Start date of employment:
Comments:
Work Performed:

Previous Employer:
Address:
Telephone Number:
Job Title:	Supervisor:
Dates employed:
From:
To:
Reason for leaving:
Work Performed:

Previous Employer:
Address:
Telephone Number:
Job Title:	Supervisor:
Dates employed
From:
To:
Comments:
Work Performed:

Applicants Statement

By submitting this application:

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. The applicant understands that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that affect is executed by the employer and employee in writing. In the event of employment, I understand that false or misleading information given in my application or interview (s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.