Online Job Application Form – Milestones Memphis

Empower Employs Online Job Application Form

Note: Fields denoted with an * are required fields.

First Name

Middle Name

Last Name

Address

City

State

Zip Code

Home Phone

Mobile Phone

Are you eligible to work in the U.S.?

Are you at least 18 years or older?

Have you ever been terminated from employment or asked to resign by an employer?

If yes, to the question regarding termination or resignation, please provide company names and details.

Can you work any shift?

Can you work overtime, including weekends?

If you can't work any shift, please explain below and indicate which shifts you CAN work.

Are you able to perform essential functions of the job you are applying, with our without a reasonable accomodation?

Are you able to provide your own transportation to and from any assigned work location on a regular and timely basis?

If you cannot provide your own transportation, how do you plan to get to and from the work location?

Date you can start

Hourly Rate desired

Position desired

Are you currently employed?

If currently employed, may we inquire of your present employer?

How did you hear about us (you can choose more than one)

If other or Referral, please describe

Do you know anyone who works for Empower Employs?

If you said yes, you do know someone, please include their name.

Choose highest level of education completed

If you graduated high school, where did you attend?

Name of other schools attended (Tech, College, etc.)

Name of current employer, if any

Employer's Phone Number

When did you start and leave?

Employer's Address

Your job title

Explain your job responsibilities there.

What is your reason for leaving?

Name of previous employer

Previous Employer's Phone Number

When did you start and leave the previous employer?

Previous Employer's Address

Your job title at your previous employer's

Explain your job responsibilities at your prevoius employer's

What was your reason for leaving your previous employer?

Do you have any special skills, experience and/or work training

Reference 1 - Full Name

Reference 1 - Address

Reference 1 - Telephone

Reference 2 - Full Name

Reference 2 - Address

Reference 2 - Telephone

Refernce 3 - Full Name

Reference 3 - Address

Reference 3 - Telephone

Use the space below to add any additional comments you would like for us to consider. The info you provide in this space is completely voluntary and is not required.

Please read carefully before accepting.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Empower Employs, LLC to hire me. If I am hired, I understand that either Empower Employs, LLC or I can terminate my employment at any time and for any reason, with our without cause and without prior notice. I understand that no respresentative of Empower Employs, LLC has the authority to make any assurance to the contrary. I attest by checking this box that I have given Empower Employs, LLC true and complete information on this online application. No requested information has been concealed. I authorize Empower Employs, LLC to contact references as provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Today's Date

Your Full Name (as your signature)