EMPLOYMENT APPLICATION


WE ARE AN EQUAL OPPORTUNITY EMPLOYER
We consider applicants for all positions without regard to race, color, religion, creed, gender, age, national origin, disability, which can be reasonably accommodated without undue hardship, veteran status, or any other legally, protected classification.


This is an application for a position in our Buffalo call center     (Click here if not correct)

 


Date of application: 8/4/2015


Email Address:
   

Please verify your email by re-entering it below
     

 
Last Name

 
First Name

Middle Name

( )            
Main Contact Telephone
( )      
Secondary Phone
 
Current Address
 
City
 
County
 
State
   
Zip Code

Were you referred by a DialAmerica Employee?
 
EDUCATION
Highest Level of Education Completed:    
Will you be attaching a resume?    

BACKGROUND

1
Have you ever been employed with us in the past?     
If Yes, give dates, position and location:
2
Are you at least 18 years of age?       

3
Are you a U.S. citizen or authorized to work in the United States?  
4
Please note that a "yes" answer to any of the following questions will not necessarily disqualify you from employment. Factors such as relation to the job, the age and time of the offense, the seriousness and nature of the violation, and rehabilitation will be considered when making any employment decisions. NOTE: Before answering this question regarding criminal convictions, please refer to the instructions below if you reside or are applying for a position in California, Georgia, Illinois or New York.

a. Have you ever been convicted of a crime or offense of any kind?
Do not include convictions that were sealed, expunged or eradicated pursuant to law or a court order.
 
Explain any "yes" answer by providing the year of the conviction, the type of conviction and the outcome of the crime or offense.
b. Are you currently awaiting trial for any criminal offense?      
Please explain any "yes" answer.

INSTRUCTIONS FOR ANSWERING CRIMINAL CONVICTION ENQUIRIES

California Applicants: Do not identify convictions under California health & safety code 11357(b) or (c), 11360(b) (formerly subdivision (c) of section 11360), 11364, 11365 or 11550 related to marijuana offenses that occur two or more years before the instant application. Also, do not identify any conviction for which the record has been judicially ordered sealed, expunged or statutorily eradicated, or any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed.

Georgia Applicants: Do not identify any guilty plea that was discharged by the court under Georgia First Offender Act.

Illinois Applicants: Applicants are neither requested or required to provide information about any convictions or arrests that are part of records that have been sealed or expunged.

New York Applicants: You may answer "no record" concerning any criminal proceedings that terminated in your favor, per section 160.50 of the New York Criminal Procedure Law; any criminal proceeding that terminated in a "youthful offender adjudication," as defined in section 720.35 of New York Procedure Law; and any conviction for a "violation" that already has been sealed by the court, per section 160.55 of the New York Procedure Law.

I certify that all the information furnished in this application (and accompanying documents, if any) is true, complete and correct. I understand and agree that any falsification, misrepresentation, misleading statement or omission of fact on either this application or during the pre-hire process will be sufficient reason for disqualification from further consideration or for termination of employment.

I authorize all persons, schools, companies, corporations and organizations named in this application (and accompanying documents, if any), to release any information concerning my background, and I hereby release them and DialAmerica from any and all claims of liability in law and in equity that may arise out of the release and attainment of such information.

I understand that if employed, I must produce proper documentation to verify my eligibility to work in the United States and that if proper documentation is not produced within three (3) days of employment, termination will occur until such time as proper documentation is supplied.

I understand that if hired, my employment at DialAmerica would be "at will" and that nothing in this application or any other DialAmerica document, or an offer or acceptance of employment, creates or is an employment contract between DialAmerica and me. I understand that my employment would be for no fixed duration, and could be terminated by me or DialAmerica at any time without cause, reason, notice or other procedural requirement. I understand that no oral or written statement to the contrary shall change this relationship, or should be relied upon by me.

I understand that DialAmerica may conduct, or have a third party conduct, a background investigation on me. I further understand that any offer of employment, or subsequent employment, is conditioned upon DialAmerica’s satisfaction with the results of any such investigation.

I understand that this application for employment will only be considered for 45 days from the date it is submitted. Should I wish to be considered for employment beyond this time period, I must submit a new application.

I understand and agree that DialAmerica has the right to unilaterally modify and / or terminate any policies, practices, procedures and standards it has adopted or implemented, to the extent not limited by law.