Apply For Employment

*Required Fields

SureSource LLC. Application for Employment

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department. We are an equal opportunity employer actively supporting workplace diversity. Employment decisions are based on merit, qualifications, and abilities. We do not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, sexual orientation, national origin, age, disability, gender identity, or any other characteristic protected under law. As part of our commitment to a safe work environment, SureSource conducts pre-employment drug testing.

*Position Desired:
*Last Name:
*First Name:
*Street Address:
Additional Address:
*City:
*State:
*Zip Code:
*Primary Phone Number:		Ext:
Secondary Phone Number:		Ext:
Email Address:
*How did you hear about us/the position you are applying for?

*Are you 18 years of age or older?
If not 18, can you furnish a work permit?
*Have you ever been employed here?
If Yes, dates of previous employment:
Previous position title:
*Are you legally eligible for employment in this country?
Date available for work:
What is your desired salary:		$ per
*Type of employment desired:
		Full-time
		Part-time
		Seasonal
		Internship/Coop

*Do you have any restrictions that, without reasonable accommodation, would prevent you from fulfilling the essential functions of the job applied for? (Essential Function Capabilities disclosure available upon
request)
If yes, provide details:


Employment History Please complete ALL sections beginning with your most recent employment/assignment/volunteer activity. Do NOT complete this section by entering “see resume”. (Your resume cannot be considered a part of this legal hiring document.)

*Employer Name:
*Employer Street Address:
Additional Employer Street Address:
*Employer City:
*Employer State:
Employer Zip Code:
*Employer Phone Number:		Ext:
*Immediate Supervisor:
*May we contact for a reference?:
*Dates of Employment: From:
*Dates of Employment: To:
*Final Job Title:
*Final/Current Salary:		$ per
*Reason for leaving?:
*Summarize the nature of work performed/job responsibilities:

Employer Name:
Employer Street Address:
Additional Employer Street Address:
Employer City:
Employer State:
Employer Zip Code:
Employer Phone Number:		Ext:
Immediate Supervisor:
May we contact for a reference?:
Dates of Employment: From:
Dates of Employment: To:
Final Job Title:
Final Salary:		$ per
Reason for leaving?:
Summarize the nature of work performed/job responsibilities:

Employer Name:
Employer Street Address:
Additional Employer Street Address:
Employer City:
Employer State:
Employer Zip Code:
Employer Phone Number:		Ext:
Immediate Supervisor:
May we contact for a reference?:
Dates of Employment: From:
Dates of Employment: To:
Final Job Title:
Final Salary:		$ per
Reason for leaving?:
Summarize the nature of work performed/job responsibilities:
Summarize any training, skills, licenses and/or certifications that may qualify you as being able to perform job related functions in the position for which you are applying.