Position in the San Diego Call Center of DialAmerica

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 San Diego call center (Click here if not correct)

Email Address: Date of application: 5/23/2013

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?
Yes No

EDUCATION

Highest Level of Education Completed:

Will you be attaching a resume? Yes No

BACKGROUND

Have you ever been employed with us in the past? Yes No

If Yes, give dates, position and location:

Are you at least 18 years of age? Yes No

Are you a U.S. citizen or authorized to work in the United States? Yes No

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. Yes No

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? YesNo

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 indentify 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 ajudication," 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 under the penalty of perjury that I am the individual listed above and the information I have provided is true and accurate.