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EMPLOYMENT APPLICATION (A)
IMPORTANT NOTICE: THIS IS A VERY SIGNIFICANT DOCUMENT. YOU SHOULD BE VERY CAREFUL AS YOU COMPLETE IT. ANSWER EACH ITEM ACCURATELY AND COMPLETELY. FAILURE TO DO SO MAY RESULT IN YOUR NOT BEING CONSIDERED FOR THE POSITION OR IN YOUR TERMINATION IF INACCURATE OR OMITTED INFORMATION IS DISCOVERED AFTER YOUR EMPLOYMENT HAS BEGUN.
ALL APPLICATIONS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN , MARITAL STATUS, AGE, RELIGION, DISABILITY OR VETERAN STATUS AS PRESCRIBED BY LAW. |
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| If you already applied for a job with our company, please login to your profile first. |
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| * Required field |
| General Information |
| Name: |
Social Security #: |
| First:* |
Last:* |
Middle Initial: |
Email Address:*
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Password (create own):*
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Confirm Password:*
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Current Address:*
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City:*
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Province or State:*
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| Zip or Postal Code:* |
Country:*
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| Current Telephone #:* |
Mobile Telephone #: |
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Permanent Address:*
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City:*
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Province or State:*
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| Zip or Postal Code:* |
Country:*
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| Permanent Telephone #:* |
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| Alternate Telephone #: |
| Education:*
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| Job Ref. # (if applicable) |
| Employee Referral (name of person): |
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| Years of emergency, relief, public health for developing country, work:
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| Available for Assignment Term of* |
| How did you learn of the open position?:*
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| Please Specify: |
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Fluency Level (1):
(SHIFT or CTRL for multi selection) |
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Language Skills (2):
(SHIFT or CTRL for multi selection) |
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Fluency Level (2):
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Language Skills (3):
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Fluency Level (3):
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Language Skills (4):
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Fluency Level (4):
(SHIFT or CTRL for multi selection) |
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| Salary: |
| Current Job Title: |
| Type:
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| Availability Date:*
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| Resume:* |
(Please cut and paste your Resume here) |
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| Passport Information |
| Passport #: |
Country of Issue: |
| Date Issued: Month / Day / Year |
Date Expired: Month / Day / Year |
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| Previous IMC Experience |
| Ever applied to IMC before?
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When: Month / Day / Year |
| Ever worked for IMC before?
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Where: |
| Was termination voluntary or involuntary?: |
Exact reason(s) for leaving:
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| Name of last supervisor at IMC: |
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| Additional Information |
| Are you able to perform the essential functions of the job for which you are applying
with or without accommodations?
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| Do you take any illegal drugs?
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Describe fully:
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| Do you use alcohol to the extent that it would impair your job performance?
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Describe fully:
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| Is there any reason why you would not be able to fully conform to all attendance requirements?
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Describe fully:
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| Have you ever been convicted of (or pleaded guilty or nolo contendere to) a crime within the past seven years? (Do not
identify marijuana-related misdemeanor convictions occurring more than two years ago or convictions for which the
criminal record has been expunged, sealed or eradicated by the court, or misdemeanor convictions for which any
probation has been completed and the case dismissed by the court.)
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| # of times |
| Did the conviction(s) (or guilty or nolo contendere plea) result in imprisonment?
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| # of times |
Explain each conviction (and guilty or nolo contendere plea) fully. (A conviction (or guilty or nolo contendere please)
will not necessarily disqualify an applicant.)
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| Are you currently charged with an unresolved criminal charge (a charge which has not yet resulted in a plea, trial, or a
dropping of the charge, or for which you are out on bail or on your own recognizance pending trial)?
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Explain fully. (A charge will not necessarily disqualify an applicant.)
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| Employment History |
| Present or Last Employer |
| Name: |
Address:
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City:
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Province or State:
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| Zip or Postal Code: |
Country:
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| Starting Date: Month / Day / Year |
Leaving Date: Month / Day / Year |
| Starting Salary: US $ (Per month) |
Final Salary: US $ (Per month) |
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| Job Title: |
May we contact immediate supervisor?
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| Name and title of immediate supervisor: |
| Name |
Title |
| Telephone #: |
Email: |
Description of Work:
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| Was termination voluntary or involuntary? |
Exact Reason(s) for leaving:
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| Former Employer |
| Name: |
Address:
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City:
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Province or State:
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| Zip or Postal Code: |
Country:
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| Starting Date: Month / Day / Year |
Leaving Date: Month / Day / Year |
| Starting Salary: US $ (Per month) |
Final Salary: US $ (Per month) |
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| Job Title: |
May we contact immediate supervisor?
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| Name and title of immediate supervisor: |
| Name |
Title |
| Telephone #: |
Email: |
Description of Work:
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| Was termination voluntary or involuntary? |
Exact Reason(s) for leaving:
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| Former Employer |
| Name: |
Address:
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City:
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Province or State:
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| Zip or Postal Code: |
Country:
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| Starting Date: Month / Day / Year |
Leaving Date: Month / Day / Year |
| Starting Salary: US $ (Per month) |
Final Salary: US $ (Per month) |
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| Job Title: |
May we contact immediate supervisor?
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| Name and title of immediate supervisor: |
| Name |
Title |
| Telephone #: |
Email: |
Description of Work:
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| Was termination voluntary or involuntary? |
Exact Reason(s) for leaving:
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| References |
| Please note at least two references: current or former direct supervisors (do not list relatives). |
| Name: |
Position held: |
Address:
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City:
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Province or State:
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| Zip or Postal Code: |
Country:
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| Telephone #: |
Email: |
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| Name: |
Position held: |
Address:
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City:
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Province or State:
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| Zip or Postal Code: |
Country:
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| Telephone #: |
Email: |
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| Name: |
Position held: |
Address:
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City:
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Province or State:
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| Zip or Postal Code: |
Country:
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| Telephone #: |
Email: |
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| EEO Information |
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Provision of the following information is entirely voluntary and kept separate from your resume.
In accordance with federal government guidelines, Human Resources use the data for statistical purposes
only. A decision to provide or not provide such information will have no effect on the company's employment
decision, and the information will not be given to the hiring manager. Applicants are considered for positions
without consideration of their race, color, religion, sex, national origin, sexual preference, age, marital status,
medical condition, disability or other legally protected status.
*Click here for definitions |
| Language Skills (1):
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| Gender (Optional):
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| Voluntary Self Designation (Optional):
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| Nationality |
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| Authorization |
| Please read carefully and answer each paragraph before signing. |
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I declare under penalty of perjury that the facts contained in this application or any resume or other documentation
submitted are true and complete to the best of my knowledge. I understand that any false information or significant
omissions will disqualify me from further consideration for employment, and will be justification for my dismissal from
employment, if discovered at a later date.*
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I agree to immediately notify IMC if I should be convicted of any crime while my job application is pending or during
my period of employment, if hired.*
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I understand that IMC may be requesting information or a report to contain pertinent information permitted by law from
various local, state, federal agencies, and former employers. I understand that the report may include information as to
my character, general reputation, personal characteristics, work habits, performance and experience, along with reasons
for termination of past employment from previous employers. I voluntarily and knowingly authorize the release of all
information requested by IMC.*
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I authorize the investigation of all statements contained in this application (and accompanying resume) and further
authorize any person, school, current employer (except as expressly noted), past employer(s) and organizations named in
this application form (and accompanying resume) to provide IMC information and opinion that may be useful in making
a hiring decision. I release all informants from all liability for any damage that may result from furnishing information
and opinion (which is truthful or made in good faith) to you.*
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I understand that, if hired, I may not hold other employment, nor engage in other activities that create a conflict of interest
with my position with IMC, unless given permission in writing by the executive office.*
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| Agreement for At-Will Employment |
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If I become employed, in consideration of my employment, I agree that my employment will be At-Will, and may be
terminated with or without cause, and with or without notice, at any time at the option of myself or IMC. Only the
President and CEO of IMC has the authority to enter into an employment agreement for a specified period of time
or termination only for cause, and such agreement must be in writing. I understand and acknowledge that this
constitutes the entire agreement between me and IMC regarding the term of my employment and supersedes
any other oral or written agreement.*
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| Compliance with Rules |
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If I become employed, in consideration of my employment, I agree to comply with the rules, regulations, policies and
procedures of IMC.*
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| Signature*
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