MARC Employment Application

  MARC
2701 NORTH A STREET, MIDLAND, TX  79705 (432) 498-8590

IF YOU ARE NOT TRUTHFUL, OR IN ANY WAY FALSIFY INFORMATION GIVEN AS PART OF THIS APPLICATION, YOU WILL BE AUTOMATICALLY INELIGIBLE FOR/TERMINATED FROM EMPLOYMENT WITH MARC.
Personal Information
Name *:
Primary Phone *:
Alternative Phone:
Email Address *:
Street Address *:
City/State/Zip *:
Position Applied For *:
Date available for work *:
Basic Qualifications
Please answer all of the following questions.
1. Are you at least 18 years of age?
2. Are you legally eligible to work for our company in the United States?
3. Have you worked for MARC before?
If yes, please provide dates.
4. Have you ever applied for employment with MARC before? 
If Yes, please give dates:
5. Will you undergo pre-employment drug testing?(You will be required to pass a drug screening test before employment.)
6. Do you have a valid Texas State Drivers License
7. Have you had any moving violations on your motor vehicle record in the past three (3) years?
(A motor vehicle record will be obtained and you must be an acceptable driver with a Texas driver's license.)
8. Have you been convicted of a criminal offense?
If yes, please explain (Texas law prohibits MARC from hiring individuals convicted of certain crimes.)
9. List any relatives who work for us.
10. Write a brief paragraph about yourself, why you want this job and your qualifications for the job *:
Additional Qualifications
1. Are you currently CPR certified? (Helpful but not required for hiring.)
2. Were you referred to MARC by a current employee?
If so, who?
If you were not referred by an employee, how did you hear about us?
Employment History
Most Recent Employer
Employer:
Address:
Phone:
Position Held:
Date Employment Began:
Date Employment Ended:
Last Pay Rate:
Supervisor:
Summarize the nature of the work
performed and job responsibilities.
Reason For Leaving:

Prior Employer (1)
Employer:
Address:
Phone:
Position Held:
Date Employment Began:
Date Employment Ended:
Last Pay Rate:
Supervisor:
Summarize the nature of the work
performed and job responsibilities.
Reason For Leaving:

Prior Employer (2)
Employer:
Address:
Phone:
Position Held:
Date Employment Began:
Date Employment Ended:
Last Pay Rate:
Supervisor:
Summarize the nature of the work
performed and job responsibilities.
Reason For Leaving:

Prior Employer (3)
Employer:
Address:
Phone:
Position Held:
Date Employment Began:
Date Employment Ended:
Last Pay Rate:
Supervisor:
Summarize the nature of the work
performed and job responsibilities.
Reason For Leaving:
Education BackGround

High School
School:
City:
State:
Diploma:

College/ University
School:
City:
State:
Diploma:
Deg/Cert/Dip:
Area of Study:

College/ University
School:
City:
State:
Diploma:
Deg/Cert/Dip::
Area of Study:

Other School
School:
City:
State:
Diploma:
Deg/Cert/Dip::
Area of Study:
Applicant's Text Resume
If you would like to submit a resume, please enter text your resume here.
Applicant's Certification Agreement
1. I understand that MARC will make inquiries, including but not limited to my:

1) EDUCATION
2) PROFESSIONAL LICENSING
3) CRIMINAL HISTORY
4) MISCONDUCT HISTORY
5) DRIVING HISTORY
6) EMPLOYMENT HISTORY
7) NURSES' AIDE REGISTRY
8) MED-AIDE REGISTRY

2. Furthermore, I understand that MARC may request information from various federal,state and other agencies that maintain records concerning my past criminal history, driving history, employment history, military history, civil and other experiences.
3. I understand that according to the Fair Credit Reporting Act I am entitled to know if employment is denied because of information obtained by MARC from a consumer reporting agency. Upon written request, I will be informed whether an investigative consumer report was requested and will be given information as to the nature and scope of this investigation, as well as the name of the reporting agency or sources of information.
4. I authorize without reservation, all persons and entities (including, but not limited to, businesses, former employers, law enforcement authorities, federal and state agencies, educational institutions and private information bureaus or repositories) contacted by MARC to furnish any or all of the above mentioned information. In addition, I hereby release MARC from any and all liability for damages arising from the investigation and disclosure of the requested information
5. I further release and discharge all liability from all companies, agencies,officials, officers, employees and other persons, who, in good faith, provide to MARC the above mentioned information as requested, in order to successfully complete my background investigation.
6. I will allow a photocopy of this authorization to be as valid as the original.
7. I agree that MARC may investigate all references listed on this application or on any resume I submit to MARC, and I hereby release MARC and its representatives from any liabilities arising out of such investigation. I further release all other persons, corporations, or organizations from any liabilities arising from furnishing such information to MARC pursuant to such investigation. I further acknowledge that MARC may secure additional job-related information about me through the investigation of any and all public records. I agree that MARC may at any time release any information it deems appropriate concerning my employment with MARC to anyone whom MARC determines has a reasonable basis for making such an inquiry.
8. I acknowledge and agree that completion of this application shall not be constituted as creating a contract or as guaranteeing employment with MARC.
9. I understand and agree that misrepresentation of facts in this application or in any resume I submit to MARC will be grounds for rejection of this application and/or that I may be terminated if I have been employed.
Type Name in Signature Box *:
Today's Date: Thu Sep 2010 9 5:15:23 MDT