PERSONAL  DATA:

 Full name
 Last Name:      First Name:      Middle Name:

Maiden/Former or Other Names:
 
 Address
 Street:      City:       State:      Zip Code:

 Telephone #:                   Social Security Number: - -

Date of Birth:           Driver's License Number:     State:

 Position Applying For:         Shift(s) Preferred:

 If hired, when would you be available to start work?

 Are you legally eligible to work in the United States?   Yes   No

 Are you over the age of 18?   Yes  No

 Who referred you to NAC?

 Have you ever been employed by NAC?  Yes  No
 If Yes, When? Employment Dates From To
 Employed Under What Name If Different Than Above:

 Have you ever been convicted of a crime? Yes  No
 If yes explain:
               Conviction will not necessarily Disqualify you for a job for which you have applied for.

 Are you able to work mandatory overtime? Yes No      Are you able to work a varied work schedule? Yes No
 Are you able to work weekends (both Saturday and Sunday)? Yes No


 EDUCATION:

 High School Name and Location:
 Years Completed:     Major Field:     Do you have a high school diploma/GED? Yes No

 College Name and Location:
 Years Completed:    Major Field:   Diploma/Degree:

 Other Schooling Name and Location:
 Years Completed:    Major Field:   Diploma/Degree:


WORK EXPERIENCE:   Start with most recent employer.

 Employer's Name:    Reference Name:
 Employer's Address:   Telephone #:
 Job Title and Duties:  
 Dates Employed:  From to       May we contact for reference? Yes No
 Reason for leaving this employment:

 Employer's Name:    Reference Name:
 Employer's Address:   Telephone #:
 Job Title and Duties:  
 Dates Employed:  From to       May we contact for reference? Yes No
 Reason for leaving this employment:

 Employer's Name:    Reference Name:
 Employer's Address:   Telephone #:
 Job Title and Duties:  
 Dates Employed:  From to       May we contact for reference? Yes No
 Reason for leaving this employment:

 Employer's Name:    Reference Name:
 Employer's Address:   Telephone #:
 Job Title and Duties:  
 Dates Employed:  From to       May we contact for reference? Yes No
 Reason for leaving this employment:

 Comments (Including explanation of any gaps in employment):
 

 Skills and Qualifications – Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to
 perform job-related function in the position for which you are applying:
 

 List any additional information you would like us to consider:
 

 If applying for a position that requires driving, do you have an appropriate license? (Unless using public transportation is 
 acceptable.) Yes  No


 REFERENCES:

 List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors.
 If not applicable, list three school or personal references who are not related to you.
 Name:       Telephone Number:        Years Known:
 Name:       Telephone Number:        Years Known:
 Name:       Telephone Number:        Years Known:

 Where did you learn about NAC:  (Choose One) Temp Agency Job Center Friend/Family NAC Sign Billboard TV Ad NAC Website NAC Mailer Help Wanted Ad in Newspaper Other Newspaper Ad Other
 If  other than listed please explain:

NAC Application Acknowledgement

Please read carefully before signing.

I understand and agree that any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal or, if employed, termination from employment.  It is my understanding that North American Communications will make a thorough investigation of my entire work history and may verify all data given in my application of employment, related papers, or oral interviews.  I authorize such investigation and the giving and receiving of any information requested by NAC and I release from liability any person giving or receiving any such information.  I understand that falsification of information so given as a result of this investigation may prevent my being hired or may subject me to immediate dismissal.  Although management makes every effort to accommodate individual preference, business needs may at times make the following conditions mandatory:  overtime, shift work, a rotating work schedule, or a work schedule other than Monday through Friday.

I further understand that this is an application for employment and that no employment contract is being offered.  Employment is strictly employment at will.  Every associate with the company is employed at will for no specified term.  Each such associate may be discharged at any time, for any reason, with or without advance notice.  I understand that if I am employed, such employment is for no definite period of time and that NAC can change wages, benefits, and conditions at any time.  I further understand that no representative of the Company has any authority to enter into any agreement with me changing my status as an employee-at-will, or to make any agreement contrary to any Company policy.  

NAC, INC. Consumer Report Disclosure

This is to advise you that a consumer report or a more detailed investigative consumer report detailing your credit history and other background information may be requested by NAC as part of our employment application process.  These reports may include:

1.     Information derived from interviews with any person NAC deems to be an appropriate reference, including but not limited to the references that you supplied to NAC.  These interviews may include any questions which are considered by NAC to be relevant, including questions about your personal background, educational background, work experience, character, personality, general reputation, personal habits and mode of living.

2.     Public record information derived from inquiries with Federal, State, local and other agencies, including consumer credit, criminal records, driving records, workers compensation claims and others.

No adverse employment action will be taken by NAC on the basis of this consumer report unless you have been provided beforehand with a copy of the report and a description in writing of your rights under the Fair Credit Reporting Act.

The Fair Credit Reporting Act requires that we obtain your authorization before requesting a consumer report.  Please complete the attached authorization and release form so that we may continue the processing of your application.

NAC, INC.  Consumer Report, Investigative Consumer Report,
and Reference Checking Authorization and Release

I understand that for the purposes of evaluating me for employment, promotion, reassignment or retention as an employee or independent contractor, NAC, its divisions, subsidiaries and affiliates, and their officers, directors, employees, agents, representatives or designees, may request consumer reports or more detailed investigative consumer reports about me which may include:

1.     Information derived from interviews with any person NAC deems to be an appropriate reference, including but not limited to the references that I supplied to NAC.  These interviews may include any questions which are considered by NAC to be relevant, including questions about my personal background, educational background, work experience, character, personality, general reputation, personal habits and mode of living.

2.     Public record information derived from inquiries with Federal, State, local and other agencies, including consumer credit, criminal records, driving records, workers compensation claims and others.

I voluntarily consent and authorize NAC to request these reports.  I hereby authorize any party or agency contacted by NAC to furnish the above-mentioned information.  I further voluntarily authorize ongoing procurement of the above-mentioned reports at any time during my employment (or contract) with NAC.  I release NAC from liability for seeking, gathering and using such information in connection with my employment (or contract) and/or potential employment (or contract) with NAC.

   I have read and understand the above. By entering my initials below, and submitting this application, I acknowledge and agree to all of
    the terms and conditions stated above. This will be your legal binding signature.

    Enter your Initials here: and press the "Submit" button below when completed.