Application Form – Blueprint Consulting

EMPLOYMENT APPLICATION

Blueprint Consulting LLC fully subscribes to the principles of Equal Employment Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, disability, or any other basis prohibited by federal, state or local law. In accordance with requirements of the Americans with Disabilities Act, it is our policy to provide reasonable accommodation upon request during the application process to eligible applicants in order that they may be given a fair and full opportunity to be considered for employment.

As Equal Opportunity Employers, we intend to comply fully with applicable federal and State employment laws and the information requested on this application will only be used for purposes consistent with those laws. Applicants are only accepted for positions currently available and will only be considered for thirty (30) days from today’s date or until the position applied for is filled, whichever first occurs.

POSITION APPLIED FOR *

RESUME *

Click or drag a file to this area to upload.

DATE OF APPLICATION *

PERSONAL DATA

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

City

State

Zip Code

SALARY EXPECTATIONS *

Are there any days, shifts or hours you will not work? If yes, please explain. *

Have you taken any illegal drugs within the last 30 days? *

Have you ever been a defendant in a civil action for an international tort (intentional commission of a wrongful act)? Note: Answering “yes” does not automatically exclude you from further consideration for the position. *

Are you legally authorized to work in the United States? *

Will you now or in the future require sponsorship for employment visa status (e.g., H-1B visa status)? Note: The Federal Immigration and Reform and Control Act of 1986 requires a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment. *

EDUCATION

Please complete for all high schools and colleges/universities attended. If you have multiple degrees, please indicate only your highest degree achieved.

HIGH SCHOOL

High School Name *

High School City/State *

Diploma Earned *

COLLEGE

Please complete this section only if you have graduated from an accredited college or university program. If you have multiple degrees, please indicate the highest degree achieved.

School Name

School City/State

Degree Earned

Date Graduated

Major/Concentration

REFERENCES

Please list two people not related to you who can speak to your qualifications.

Reference 1 - Name

Reference 2 - Name

Reference 1 - Phone

Reference 2 - Phone

Reference 1 - Email

Reference 2 - Email

Reference 1 - Relationship

Reference 2 - Relationship

Have you ever been fired or forced to resign? This does not include layoffs due to company reductions-in-force (RIF) or other economic factors. *

MILITARY SERVICE

Complete only if you served in the military.

Branch of Service

Length of Service

Rank at Discharge

Date of Discharge

Reason for Leaving

CRIMINAL RECORD INFORMATION

All Applicants:

You must answer all three questions below. When answering the following questions, you may exclude any records expunged, annulled, sealed, discharged, dismissed, erased under first-offender law or otherwise eradicated by state or court order. You may also exclude a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace.

A criminal conviction will not necessarily be a bar to employment but will be considered in relation to job requirements.

Have you been convicted of a felony in the last seven years? *

Have you been convicted within the last seven years of misappropriation of funds, embezzlement, or similar for other dishonest misconduct; or an offense involving the use of a weapon; for burglary, robbery, breaking and entering or theft; or physical assault or other violent crime? *

Have you been convicted of or completed a period of incarceration within the past five years for any misdemeanor? *

APPLICANT’S ACKNOWLEDGEMENT

I hereby certify that I have read and fully understand this application. Prior to signing below, I had the opportunity to ask Blueprint Consulting about this application and to clarify any questions I might have had concerning the application form. I hereby certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers may disqualify me from further consideration of employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document may be cause for my dismissal at any time without prior notice. I consent to and authorize Blueprint Consulting to contact my former employers, references, and any and all other persons or organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools and personal references to give Blueprint Consulting (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have and hereby waive any actions which I might have against either party(ies) for providing a good faith reference.

I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS NOT FOR A SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR MY EMPLOYER(S) WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER(S) POLICY, CUSTOM, BUSINESS PRACTICE OR OTHER PROCEDURE (INCLUDING THE BASIC EMPLOYMENT POLICIES, PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITIUTE AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND MY EMPLOYER(S). I ALSO UNDERSTAND THAT THIS ASPECT OF MY EMPLOYMENT MANY NOT CHANGE ABSENT AN INDIVIDUAL WRITTEN AGREEMENT SIGNED BY BOTH ME AND BLUEPRINT CONSULTING MANAGEMENT.

I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; submit to a background investigation; take a pre-employment drug test. If I am offered employment to start work before any required test is completed, my employment is contingent upon a satisfactory result on all required tests. I authorize Blueprint Consulting to review the results of background checks (if any) and my pre-employment drug/alcohol test (if any), any information on this application and any relevant information about me. I further authorize the release of any background check results of any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or other legal document.

I acknowledge that this application will remain active for 30 days from this date. If I have not heard from Blueprint Consulting at the conclusion of this 30-day period, it is my responsibility to complete a new application if I still wish to be considered for employment.

CERTIFICATION FOR ALL APPLICANTS – PLEASE READ CAREFULLY

This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge.

Signature *