Online Applications :: PREMIERE, INC

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About Premiere, Inc.

Online Applications

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, maritial or veteran status, or any other legally protected status.

*Position(s) Applied For

Date of Application

02/06/2012

*How Did You Learn About Us?

Advertisement Friend Inquiry Employment Agency Relative Other

*Last Name	*First Name	*Middle Name

*E-Mail Address

*Have you ever used any other name(s) which is (are) necessary for us to verify your employment or educational record?
No Yes	Name:

*Present Address	*City	*State	*Zip Code

Please provide your addresses for the last (3) years:
*Former Address	*City	*State	*Zip

Telephone Number(s)

*1: -- *2: -- 3: --

*Social Security Number

*Driver's License No.	*State	*Expiration Date	Class/Endorsements (If applicable)

*A.

Best time to contact you at home is:

*B.

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes No

*C.

Have you ever filed an application with us before?

Yes No

*D.

Have you ever been employed with us before?

Yes No

*E.

Are you under any type of agreement that would prevent you from performing the job for which you are applying or for which you are being considered, such as non-competition, non-disclosure, or non-solicitation agreement?

Yes No

*F.

Do any of your friends or relatives, other than spouse, work here?

Yes No

*G.

Are you currently employed?

Yes No

*H.

May we contact your present employer?

Yes No

*I.

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.

Yes No

*J.

Date available for work

*K.

What is your desired salary range?

*L.

Are you available to work:

Full Time

Part Time

Temporary

*M.

Are you currently on "lay-off" status and subject to recall?

Yes No

*N.

Can you travel if a job requires it?

Yes No

EDUCATION

School	Name and Address of School	Course of Study	No. Years Completed	Diploma / Degree
High School
Undergraduate College
Graduate/Professional
Other (Specify)

ADDITIONAL INFORMATION
State any additional information you feel may be helpful to us in considering your application, including any job related training in the U.S. Military.

*O.	Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. Are you capable of performing in a reasonable manner, with or without a reasonable accomidation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.	Yes No
*P.	Do you currently possess a Transportation Worker Identification Credential (TWIC)?	Yes No
	If Yes, Card # Expiration Date:
*Q.	Have you ever been convicted or adjudicated of a crime (California applicants see below)?	Yes No
*R.	Are you currently under any investigation or pending charge?	Yes No
*S.	Are you currently awaiting trial for any criminal offense?	Yes No
*T.	Have you ever initiated an act of violence in the workplace?	Yes No
*U.	Have you ever been sanctioned or had your driver's license suspended or revoked?	Yes No

EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any job related military service assignments and volunteer activities. Exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

1.

*Employer

*Dates Employed

*Work Performed

From

*Hourly Rate/Salary

Starting

Final

*Address

*Telephone Number(s)

*Starting/Present Job Title

*Supervisor

*Reason for Leaving

*May We Contact

Yes No

Employer

Dates Employed

Work Performed

From

Hourly Rate/Salary

Starting

Final

Address

Telephone Number(s)

Starting/Present Job Title

Supervisor

Reason for Leaving

May We Contact

Yes No

Employer

Dates Employed

Work Performed

From

Hourly Rate/Salary

Starting

Final

Address

Telephone Number(s)

Starting/Present Job Title

Supervisor

Reason for Leaving

May We Contact

Yes No

REFERENCES Do not include family members or past supervisors.

Name	Phone Number	Best Time to Call	Occupation
1.	--
2.	--
3.	--

QUESTIONNAIRE

Do you require sponsorship to work in the U.S.?	YES Maybe No
Can you get a PASSPORT?	YES Maybe No
Are you willing to take a hair sample drug test?	YES Maybe No
What type of schedule are you looking for?
Are you open to relocation?	YES Maybe No
What are your hobbies outside of work?
Are you willing to work 24/7 call on a rotational board?	YES Maybe No
Do you have a problem being away from home several days at a time?	YES Maybe No
Are you willing to work weekends and holidays?	YES Maybe No
Does your family have a problem with you being gone for 2 to 3 weeks at a time?	YES Maybe No
Do you like working overtime?	YES Maybe No
Are you willing to work long hours?	YES Maybe No
Do you have any traffic or non-traffic violations in the last 5 yrs including DUI, DWI, Felonies or misdemeanors?	YES Maybe No
What type of work are you currently doing?
Do you want to work outside or inside?
Do you prefer cold weather or hot weather?
Are you willing to work in all types of weather?	YES Maybe No
Are you comfortable in a field setting?	YES Maybe No
Are you willing to be paid by direct deposit?	YES Maybe No
What position do you see yourself in in 5 years?
Are you looking for a job or a career?
What is the most important thing to you when starting a new career?
Do you like to travel?	YES Maybe No
What is the shortest time you've ever worked for a company?
What is the longest time you have ever worked at for a company?
Do you see yourself moving to another company for $.25 more an hour?	YES Maybe No
Do you have reliable transportation?	YES Maybe No
On a scale of 1 to 10, 10 being the best, rate yourself as a team player.
On a scale of 1 to 10, 10 being the best, where would your best friend rate you on trust?
On a scale of 1 to 10, 10 being the best, where would you rate yourself on willingness to learn?
On a scale of 1 to 10, 10 being the best, where would you rate your willingness to change?
Why do you want to work for this company?

APPLICANT'S STATEMENT

I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is furthur understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Employer.
I authorize the Company to conduct any necessary investigations or inquiries regarding my background to the extent permitted by federal, state and local law. I agree to complete the requisite authorization forms for the background investigation. I hereby release all parties from any liability in connection with the provision and use of such information.
I consent to all of the following pre-employment processes, which are required by the Company and I further understand that the offer of employment is contingent upon my successfully completing all of pre-employment testing:
1. Motor Vehicle Report (MVR) (review of past driving record)
2. Drug screen (DOT and Non-DOT applicants)
3. Previous Employer Drug and Alcohol History (DOT applicants, 49 CFR 382.413)
4. Physical Examination and Functional Capacity Evaluation (consistent with federal and state law)
5. Background Check

AUTHENTICATION CODE

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