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Legal First Name:
Legal Last Name:
Primary Phone #:
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How did you hear about us?
Agency (Please Specify)
I am a Current Employee
Indeed Sponsored Job
Lee Hecht Harrison
Michigan Pure Talent
Other (Please Specify)
Pittsburgh Technology Council
Suggest the Best
US.jobs Resume database
Other (Specify Source):
If an employee referred you, please specify employee's name.
Are you legally eligible for employment in the United States?
Eligible to Work in U.S.:
Are you 18 years of age or older?
Do you consent to a criminal background check if an offer is made?
Have you ever been employed by TechTeam, National TechTeam, TechTeam Global, Stefanini TechTeam, Stefanini IT Solutions, Code X, Inc., CXI, RCG Staffing, or Computer Trade Development Corporation? If Yes, please list termination date and reason for leaving.
Education and Skills:
I hereby certify that all information furnished by me on this application and in any attachment(s) is true and complete. I understand that falsification, distortion, or omission of any of the aforementioned information is grounds for immediate dismissal, regardless of when such omission or misrepresentation may be discovered by Stefanini. I authorize Stefanini to investigate all statements in this application, including the records of former employers, police departments, and other references and sources concerning me. I authorize all such references and sources to release this information without liability for damage incurred in giving it. I waive any notice of the release of such records that may be required by state or federal law.
I authorize Stefanini to conduct a credit check on me when required for my position. I understand that Stefanini is a drug free environment. Accordingly, I expressly agree and consent to submit to a drug test before and after hire. I authorize the results of the drug test to be released to Stefanini. If hired, I agree to conform to the rules and regulations of Stefanini. I understand that my employment and compensation is "at will" and can be terminated with or without cause, with or without notice, at the option of Stefanini or myself.
I further understand that Stefanini or any agent of Stefanini shall have the maximum discretion permitted by law to administer, interpret, modify or discontinue, enhance, or otherwise change all policies, procedures, benefits, or other terms or conditions of employment. I agree, in partial consideration of employment, that I shall not commence any action or other legal proceeding relating to my employment or the termination thereof more than six (6) months after termination of such employment and agree to waive any statute of limitation to the contrary.
I HAVE READ AND UNDERSTAND THIS APPLICATION AND THE QUESTIONS, STATEMENTS, AND CONDITIONS OF EMPLOYMENT CONTAINED HEREIN
Format: M/D/YY *
Under the Michigan Handicappers Civil Rights Act, a handicapper may allege a violation of the Act regarding the failure to accommodate only if the handicapper notifies the employer in writing of the need for accommodations within 182 working days after the date the handicapper knew or reasonably should have known that an accommodation was needed.
Voluntary Equal Opportunity Questionnaire
As an equal opportunity employer, we hire without consideration to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, veteran status or disability. We invite you to complete the optional self-identification fields below used for compliance with government regulations and record-keeping guidelines.
Choose Not to Disclose
American Indian or Alaska Native (not Hispanic or Latino)
Asian (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
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Hispanic or Latino
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)
Two or More Races (not Hispanic or Latino)
White (not Hispanic or Latino)
Armed Forces Service Medal Veterans
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Other Protected Veterans
Recently Separated Veterans
Candidate Individual with disabilities:
Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2020
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.
i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the US. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.